Abstract

Background: The attainment of target serum low-density lipoprotein cholesterol (LDL-C) levels and the prescription rates of high-intensity stain (HIS) and ezetimibe among high-risk patients in Taiwan remain unsatisfactory. We hypothesized that reminding individualized target LDL-C values to physicians and patients improved the attainment.

Methods: Between July 2018 and December 2019, 214 high-risk patients with suboptimal LDL-C levels in the Lipid Clinic of our institution, including 100 patients with coronary artery disease (CAD), were enrolled. Each patient received prescription of lipid-lowering medications supported by an intelligent checklist-assisted reminding approach and informed individualized target serum LDL-C levels. The LDL-C goal attainment rates and the prescription rates of HIS/ezetimibe of patients were analyzed every 3 months.

Results: Patients with CAD at enrollment had a higher rate of stain prescription, lower baseline serum LDL-C levels, and a wider gap to reach serum LDL-C goals, compared to those without CAD. The prescription rates of HIS/ezetimibe at baseline, 3-month, 6-month, and 9-month follow-ups in patients with CAD were respectively 25.0%/8.0%, 78.6%/51.0%, 78.6%/69.0%, and 87.5%/82.1%, while those in patients without CAD were respectively 6.1%/9.6%, 70.8%/26.5%, 66.7%/33.3%, and 78.3%/43.5%. The LDL-C goal attainment rates at 3-month, 6-month, and 9-month follow-ups in patients with CAD were respectively 58.8%, 62.0%, and 62.5%, while those in patients without CAD were respectively 79.6%, 75.6%, and 73.9%.

Conclusion: The intelligent checklist-assisted reminding approach in electronic medical order system, accompanied by an increased prescription of HIS and ezetimibe in the Lipid Clinic effectively facilitate the improvement of LDL-C goal attainment rates in high-risk patients.