Title : Secondary prevention measure, specifically HBA1C and lipid profile, following an acute myocardial infarction audit
Abstract:
Background: Hypercholesterolaemia and poor blood glucose control are well known risk factors for developing myocardial infarction (MI). Preventative measures have been incorporated into several guidelines around the world. We aim to review our performance in adhering to the current guidelines used in our Calderdale and Huddersfield Hospitals NHS Trust, namely European Society of Cardiology (ESC) and the National institute for Health and Care (NICE).
Method: We conducted a retrospective analysis of patients who were admitted from 1st October 2022 to 31st December 2022 with a diagnosis of a myocardial infarction. We expect patients to have their LDL level checked within 48 hours of hospital admission, discharged with a maximally tolerated dose of a high intensity statin, and to have a repeat level taken in 8 weeks post MI. For blood glucose control, HBA1C level taken anytime during inpatient or within 6 months prior to the admission date. HBA1C level of 48mmol/mol in non-diabetic patients and >53 mmol/mol for known diabetes, were chosen as a cut off for a local diabetes specialist nurse (DSN) referral. Patients in the pre-diabetes category, level of 42-47 mmol/mol, mandates a note to the general practitioner on the discharge letter.
Result: Total of 200 patients were audited.
Lipid profile was checked within 48 hours of admission in 121 (61%) patients. Of those who had it checked, 71 (59%) patients had a repeat level in 8 weeks. Amongst the 71 patients, LDL was not in target in 40 (56%) patients, but only 20 (28%) patients was actioned by clinicians.
Out of 200 patients, 53 (27%) patients were not on a high intensity statin when discharged from hospital. There was an established reason for 29 (56%) patients (table 1), but none documented for the remaining 25 (44%) patients.
HBA1C level was checked in 135 (68%) patients. 39 (29%) patients were known diabetic whilst the remaining 96 (71%) patients had no prior diagnosis of diabetes mellitus (table 2). Of the 39 (29%) patients who were known diabetic, 33 (84%) did not meet the target HBA1C level of <53 mmol/mol but only 13 (39%) of them were actioned by clinicians. 33 (34%) patients met the threshold for a diagnosis of diabetes mellitus amongst those with no prior diabetes history, but only 5 (15%) patients were actioned. 25 (26%) patients had HBA1C level between 42-47mmol/mol which comes into pre-diabetic category, but none of them was actioned.
Conclusion: Although, we are addressing to improve the secondary prevention measure controlling cholesterol and blood glucose following a myocardial infarction, there is still room for improvement.
Audience Take Away:
- To remind the importance of secondary prevention following myocardial infarction, specifically lipid and blood glucose control
- The management protocol depending on the cholesterol and Haemoglobin A1C levels
- The area for improvement in practice aiming towards effective and efficient secondary prevention
