Patients with coronary heart disease (CHD) have an LDL goal of less than 70 mg/dL. A recent trial provides evidence that intensive statin therapy to reduce LDL-cholesterol levels below 100 mg/dL showed substantial clinical benefit in patients with stable CAD (LaRosa, 2005 [A]). If lipid goals are not met, it is important to intensify therapy until goals are reached. Lipid treatment is intensified within four months of an abnormal LDL value less than 20% of the time. This problem, referred to as "clinical inertia," is a major obstacle to improved lipid management. Clinical inertia is defined as failure to intensify therapy at an office visit when the patient is above his/her evidence-based goal. Studies at HPRF (HealthPartners Research Foundation) suggest that in high-risk patients such as those with diabetes or heart disease, clinical inertia may be found at over half the office visits (Phillips, 2001 [R]). Organized efforts to use decision-support tools with or without electronic medical records may help reduce the problem of clinical inertia. |