Objective: To demonstrate that management of dyslipidemia does not improve with post-graduate level advancement. Methods: Data was extracted by retrospective review of admissions for the primary diagnosis of chest pain, regardless of final diagnosis. Exclusion criteria included the lack of an ordered lipid profile or identification of chest pain as a secondary diagnosis. Data from 150 patients, from the Internal Medicine residency patient lists at our institution from 2006 to 2008, was recorded and compared with the ATP III Guidelines to classify risk factors and lipid profiles. For each patient, we identified whether appropriate treatment measures were followed and the post-graduate level of the house officer involved with the care. Appropriate treatment is defined as lifestyle modification or pharmacologic treatment. Results: Among the 150 randomly selected patients, there were 99 cases (66%, 95%-confidence interval 58%-74%) where lipid profiles were abnormal. Appropriate treatment based on guidelines was not followed in 63 cases (42%, with a 95%-confidence interval 34%-50%). Of these cases where appropriate treatment was not followed, 94 cases were handled by interns (PGY-1) and 56 cases were handled by senior residents (PGY-2 and PGY-3). The error rate among interns was 38/94 (40.4%) and the error rate among senior residents was 25/56 (44.6%). A two sample comparison of binomial proportions resulted in a p-value of 0.614, indicating that the error rates among the two groups were statistically similar. Discussion: Dyslipidemia is associated with increased morbidity and mortality in coronary heart disease (CHD) and its equivalents. ATP III Guidelines recommend treatments depending on major and minor risk factors. As a low Framingham score correlates with a lower 10-year risk of CHD, appropriate lipid management leads to improved outcome and fewer adverse/fatal events. Inadequate appreciation of cardiovascular risk stratification results in suboptimal patient care. Given our study, advancement in Internal Medicine post-graduate level fails to improve dyslipidemia management. Conclusion: Lipid management should be promoted not only at the beginning of PGY-1, but needs to be reemphasized and monitored throughout training to ensure optimal patient care.
Kazi, H. Shaik, S. Leh, D. (2012, May). Time for change: Dyslipidemia Management by Internal Medicine Housestaff. Poster Presented at: (AACE) The American Association of Clinical Endocrinologists, Philadelphia, PA.