Coronary Heart Disease : What Correlates with Repeat Lipid Testing? Interview with Salim S. Virani, MD, PhD

Health Policy and Quality Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine,
Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas What are the main findings of the study?

Dr. Virani: The main findings of the study are that despite having cholesterol levels at goal (LDL cholesterol <100 mg/dL), about one-third of patients (9200 out of 27947) with coronary heart disease had repeat cholesterol testing in 11 months from their last lipid panel. As expected, no intervention was performed as a response to these lipid panels. Collectively, 12686 additional lipid panels were performed in these patients.  Among 13,114 patients who met the optional treatment target of LDL-C<70 mg/dL, repeat lipid testing was performed in 8,177 (62.3% of those with LDL-C<70) during 11 months of follow-up.

Patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% CI, 1.10-1.22), a history of hypertension (OR, 1.21; 95%CI, 1.13-1.30), higher illness burden (OR, 1.39; 95%CI, 1.23-1.57), and more frequent primary care visits (OR, 1.32; 95%CI, 1.25-1.39) were more likely to undergo repeat testing, whereas patients receiving care at a teaching facility (OR, 0.74; 95%CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95%CI, 0.88-0.98) and those with a medication possession ratio of 0.8 or higher (OR, 0.75; 95%CI, 0.71-0.80) were less likely to undergo repeat testing. Where any of the findings unexpected?

Dr. Virani: Number of patients who underwent repeat lipid testing despite at target LDL cholesterol and no further treatment intensification. The mean LDL-C was close to 70 mg/dL in these patients and despite having such low LDL-C levels, a very high proportion of patients underwent repeat lipid testing. What should patients and health care providers take home from this report?

Dr. Virani: These results represent health care resource overuse and possibly their waste. Apart from the costs associated with these lipid panels, this also carries with it the cost for the patient’s time to undergo a repeat blood test and cost for the health care provider’s time to follow-up on these results after redundant testing and to inform the patient about these results. This results also represent an opportunity to improve health care efficiency and reduce health care waste. What further research do you recommend as a result of this study?

Dr. Virani: To identify if the frequency and correlates of redundant testing are similar for other chronic conditions and to identify interventions to reduce this redundant testing.


Correlates of Repeat Lipid Testing in Patients With Coronary Heart Disease

Virani SS, Woodard LD, Wang D, et al. Correlates of Repeat Lipid Testing in Patients With Coronary Heart Disease. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.8198.

Last Updated on June 4, 2015 by Marie Benz MD FAAD