INTRODUCTION

1. Blood pressure (BP), hemoglobin a1c (Ha1c), LDL cholesterol (LDL-C) are three key metrics for family practitioners to track in patients • Measured these metrics in medium to high-risk cardiovascular patients to determine whether or not metrics within the desired range • Proposedpossibilities for why metrics within/not within desired range This project was completed during family medicine residency at Western University (Ontario) in 2012. Special thanks to Dr. Frank DeMarco and Dr. Steve Sears for their assistance. CONCLUSIONS INTRODUCTION • Establishedrandom sample of 100 patients at family medicine clinicin Timiskaming, Ontario • Sample size a trade-off between accuracy and practicality • Utilized Framingham Risk Calculator to distinguish among low, medium and high risk • Eliminated patients with low risk from study • Reviewed four most recently recorded BP and LDL-C values for each medium and high-risk patient, plus Ha1c recordings for diabetics • Noted if measurements met desired targets set by the Canadian CardiovascularSociety, Canadian Hypertension Education Program and Canadian Diabetes Association • Desired BP = less than 140/90 for non-diabetics, 130/80 for diabetics • Desired LDL-C = less than or equal to 2 mmol/L • Desired Ha1c (diabetics) = less than or equal to 7% • Calculatedpercentage of patients who attained desired levels for eachof the three metrics METHOD 100 patient charts sampled: • 52 excluded from study (25 low-risk + 27 insufficient data to determine risk) • 23 high risk included in the study • 25 intermediate risk included in the study Of the 48 included: • 15 diabetics • Age range = 47-84, media age = 64 years • 31 males, 17 females RESULTS Excellent control of blood pressure and glycemic management by diabetics; likely attributed to: • Regular follow up by physicians • Patient adherence to physician’s lifestyle recommendations and prescribed pharmacotherapy Less satisfactory LDL cholesterol management; could be attributed to: • More stringent standard (2 mmol/L) for high-risk patients extended recently to medium-risk patients • Few effective and tolerable options for dyslipidemia (unlike hypertension and diabetes) • Statin therapy side effect of myalgia reduced patient adherence to the treatment • More limited database for LDL-C than BP (4 separate measurements of lipid levels not available for all patients + some patients may not have had blood work done at least 4 times) ACKNOWLEDGMENTS Managing cholesterol and blood sugar requires periodic blood tests, which are often deferred by patients; could be addressed by: • Reinforcing with patients importance of the lab visits • Using electronic medical system to mail/email automatic reminders to patients To improve adherence to statin therapy, consider: • Reducing the dose • Choosing another statin • Offering non-statin agents (e.g. ezetimibe, fibrates, bile acid sequestrants) Steven Lipari, MD CCFP Currently: PGY-3, Hospital Medicine, University of Toronto Preventing and Managing Chronic Disease: A Clinical Audit of Key Patient Metrics RECOMMENDATIONS District of Timiskaming, Ontario, Canada Attainment* = desired range recorded greater than half the time