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Войти в исследования European journal of internal medicine · 2026
Diagnostic and therapeutic inertia for LDL cholesterol management of consecutively verified patients with acute myocardial infarction.
СтатьяНазвание и аннотация: Перевод в очереди
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Gragnano Felice, Artana Chiara, Carrara Greta, Sacco Alice, Montalto Claudio, Mennuni Marco, Zuin Marco, D'Ascenzo Fabrizio, Nevo Fabrizio Del, De Sio Vincenzo, De Luca Leonardo, Spoto Giulia, Musumeci Giuseppe, Oliva Fabrizio, De Ferrari Gaetano Maria, Grosseto Daniele, Calabrò Paolo, Patti Giuseppe, Campo Gianluca, Leonardi Sergio, ATBV Quality Matters Investigators
Аннотация
BACKGROUND: Actionable quality gaps persist in low-density lipoprotein cholesterol (LDL-C) management after acute myocardial infarction (AMI). We aimed to quantify diagnostic and therapeutic inertia in LDL-C management after discharge in a real-world AMI population with verified and quantified consecutive inclusion.
METHODS: We conducted a quality improvement audit of patients discharged alive with a primary diagnosis of AMI. Consecutiveness was quantified using the consecutive index (e.g., the ratio of included patients with available 6-month follow-up information to the total AMI discharges). Diagnostic inertia was defined as no evidence of LDL-C measurement post-discharge. Therapeutic inertia was defined as LDL-C ≥ 55 mg/dL in the absence of optimal lipid-lowering therapy among patients with at least one post-discharge LDL-C measurement. A multivariable model was developed to identify risk-adjusted probability of LDL-C target achievement at follow-up.
RESULTS: Among 3490 AMI patients, 3130 had at least a follow-up assessment after discharge. At six months, 2603 patients had available information on vital status, follow-up assessment, and post-discharge LDL-C assessment status (consecutive index: 74.6% [95% CI: 73.1-76.0%]). Diagnostic inertia occurred in 19.3% (95% CI: 17.8-20.9%) and therapeutic inertia in 38.1% (95% CI: 35.7-40.6%). In a multivariable model, the explained variance was modest (R2=14.4%; 95% CI: 12.0-18.2%).
CONCLUSIONS: In a contemporary cohort including approximately 75% of patients surviving hospitalization for AMI, one in five patients did not undergo LDL-C testing during follow-up and two in five did not receive adequate lipid-lowering therapy despite failing to reach guideline-recommended targets. These findings highlight a substantial opportunity for structured quality improvement initiatives targeting LDL-C management after AMI.
METHODS: We conducted a quality improvement audit of patients discharged alive with a primary diagnosis of AMI. Consecutiveness was quantified using the consecutive index (e.g., the ratio of included patients with available 6-month follow-up information to the total AMI discharges). Diagnostic inertia was defined as no evidence of LDL-C measurement post-discharge. Therapeutic inertia was defined as LDL-C ≥ 55 mg/dL in the absence of optimal lipid-lowering therapy among patients with at least one post-discharge LDL-C measurement. A multivariable model was developed to identify risk-adjusted probability of LDL-C target achievement at follow-up.
RESULTS: Among 3490 AMI patients, 3130 had at least a follow-up assessment after discharge. At six months, 2603 patients had available information on vital status, follow-up assessment, and post-discharge LDL-C assessment status (consecutive index: 74.6% [95% CI: 73.1-76.0%]). Diagnostic inertia occurred in 19.3% (95% CI: 17.8-20.9%) and therapeutic inertia in 38.1% (95% CI: 35.7-40.6%). In a multivariable model, the explained variance was modest (R2=14.4%; 95% CI: 12.0-18.2%).
CONCLUSIONS: In a contemporary cohort including approximately 75% of patients surviving hospitalization for AMI, one in five patients did not undergo LDL-C testing during follow-up and two in five did not receive adequate lipid-lowering therapy despite failing to reach guideline-recommended targets. These findings highlight a substantial opportunity for structured quality improvement initiatives targeting LDL-C management after AMI.