News in brief: Australian patients not achieving LDL-C goals; Cardiac toxicity risk from azithromycin overuse; Gaps in cardiac rehab uptake for PCI patients

1 Jun 2022

Most patients not achieving LDL-C goals

More than half of Australians on combination lipid-lowering therapy are not achieving LDL-cholesterol goals, a study has shown

A retrospective cohort study of 9,173  primary care patients treated with combination therapy found that only 45.4% met the on-treatment goal for LDL-C of < 2 mmol/L as per Australian guidelines.

The median on-treatment LDL-C was 2.1 mmol/L (IQR 1.6-2.8), according to findings published in the Journal of Clinical Lipidology by a team from School of Public Health and Preventive Medicine, Monash University, Melbourne.

Patients on fixed-dose combination of statins plus ezetimibe having the highest rates of achievement (49.8%).

Factors associated with LDL-C goal achievement included male sex, aged >80 years and a history of type 2 diabetes or coronary heart disease.

The failure to meet treatment goals might be related to low rates of lipid level testing, according to the authors, who noted that only half of the patients had LDL-C measurements recorded, and there were a median of just four LDL-C measures per patient during the six year study period.

“Urgent measures are needed to address this gap in clinical practice to minimise negative health outcomes,” the study authors said.

The study was funded by Amgen Australia.

Cardiac toxicity risk from azithromycin overuse

Inappropriate prescribing of azithromycin for community-acquired pneumonia is putting patients at risk of QTc interval prolongation and life-threatening cardiac arrhythmias, according to a report from NSW.

A review of 100 patients at St George Hospital, Sydney. who were prescribed the macrolide for CAP found that one third (33%) did not have ECGs documented and of those that did, 15% were prescribed azithromycin despite having prolonged QTc intervals.

For patients with prolonged QTc intervals, the calculated QTc intervals ranged from 446 to 487 ms, with the average QTc interval being 464 ms. The average age of patients with prolonged QTc intervals was 82 years and many had a background of other cardiovascular diseases, including atrial fibrillation, congestive cardiac failure, ischaemic heart disease, valvular abnormalities and previous pacemaker insertion.

Of the 10 patients with prolonged QTc intervals on admission, only two had follow-up ECGs during their admission and three did not have their serum calcium or magnesium checked during their admission.

Of concern was the finding that four of the patients with prolonged QTc intervals were also prescribed other QT prolonging medications while taking azithromycin, the study investigators said.

While there were no cardiac arrhythmias reported in this sample patients, the authors said the findings suggested an unmet need for screening ECG prior to azithromycin administration, monitoring QTc intervals while on azithromycin, and optimisation of other factors which may contribute to prolonged QTc interval, such as monitoring serum electrolytes, as well as avoidance of other QTc prolonging medications when possible.

More information: Internal Medicine Journal

Gaps remain in provision of cardiac rehab for PCI patients

More effort is needed to get patients referred to outpatient cardiac rehabilitation following percutaneous coronary intervention, a VIctori study suggests.

The review of data for 41,739 PCI patients discharged following PCI over the period 2017–2020 found that overall cardiac rehabilitation referral rates were high at 85%, with an increasing trend over time.

However referral were less likely for patients who were treated in public hospital, those who had procedures  in centres with lower volumes of ST-elevation myocardial infarction patients (STEMI) and patients with shorter hospital stays.

PCI patients with an acute coronary syndrome who were referred to outpatient cardiac rehabilitation were also more likely to be prescribed four or more major preventive pharmacotherapies, compared to those who were not referred (90% vs 82.1%, p<0.001), the study showed.

Automated cardiac rehabilitation referral systems and provider incentives may help improve uptake, the study authors wrote in Heart Lung and Circulation.

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