Background Actionable quality gaps persist in low-density lipoprotein cholesterol (LDL-C) management after acute myocardial infarction (AMI). We aimed to quantify diagnostic and therapeutic inertia in LDL-C management after discharge in a real-world AMI population with verified and quantified consecutive inclusion. Methods We conducted a quality improvement audit of patients discharged alive with a primary diagnosis of AMI. Consecutiveness was quantified using the consecutive index (e.g., the ratio of included patients with available 6-month follow-up information to the total AMI discharges). Diagnostic inertia was defined as no evidence of LDL-C measurement post-discharge. Therapeutic inertia was defined as LDL-C ≥ 55 mg/dL in the absence of optimal lipid-lowering therapy among patients with at least one post-discharge LDL-C measurement. A multivariable model was developed to identify risk-adjusted probability of LDL-C target achievement at follow-up. Results Among 3490 AMI patients, 3130 had at least a follow-up assessment after discharge. At six months, 2603 patients had available information on vital status, follow-up assessment, and post-discharge LDL-C assessment status (consecutive index: 74.6% [95% CI: 73.1–76.0%]). Diagnostic inertia occurred in 19.3% (95% CI: 17.8–20.9%) and therapeutic inertia in 38.1% (95% CI: 35.7–40.6%). In a multivariable model, the explained variance was modest (R2=14.4%; 95% CI: 12.0–18.2%). Conclusions In a contemporary cohort including approximately 75% of patients surviving hospitalization for AMI, one in five patients did not undergo LDL-C testing during follow-up and two in five did not receive adequate lipid-lowering therapy despite failing to reach guideline-recommended targets. These findings highlight a substantial opportunity for structured quality improvement initiatives targeting LDL-C management after AMI.
Diagnostic and therapeutic inertia for LDL cholesterol management of consecutively verified patients with acute myocardial infarction
Gragnano, Felice;De Sio, Vincenzo;Calabro', Paolo;
2026
Abstract
Background Actionable quality gaps persist in low-density lipoprotein cholesterol (LDL-C) management after acute myocardial infarction (AMI). We aimed to quantify diagnostic and therapeutic inertia in LDL-C management after discharge in a real-world AMI population with verified and quantified consecutive inclusion. Methods We conducted a quality improvement audit of patients discharged alive with a primary diagnosis of AMI. Consecutiveness was quantified using the consecutive index (e.g., the ratio of included patients with available 6-month follow-up information to the total AMI discharges). Diagnostic inertia was defined as no evidence of LDL-C measurement post-discharge. Therapeutic inertia was defined as LDL-C ≥ 55 mg/dL in the absence of optimal lipid-lowering therapy among patients with at least one post-discharge LDL-C measurement. A multivariable model was developed to identify risk-adjusted probability of LDL-C target achievement at follow-up. Results Among 3490 AMI patients, 3130 had at least a follow-up assessment after discharge. At six months, 2603 patients had available information on vital status, follow-up assessment, and post-discharge LDL-C assessment status (consecutive index: 74.6% [95% CI: 73.1–76.0%]). Diagnostic inertia occurred in 19.3% (95% CI: 17.8–20.9%) and therapeutic inertia in 38.1% (95% CI: 35.7–40.6%). In a multivariable model, the explained variance was modest (R2=14.4%; 95% CI: 12.0–18.2%). Conclusions In a contemporary cohort including approximately 75% of patients surviving hospitalization for AMI, one in five patients did not undergo LDL-C testing during follow-up and two in five did not receive adequate lipid-lowering therapy despite failing to reach guideline-recommended targets. These findings highlight a substantial opportunity for structured quality improvement initiatives targeting LDL-C management after AMI.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
