Endocrine Abstracts

Hyperlipidaemia services in the UK are guided by National Guidance for Lipid Management for primary and secondary prevention of cardiovascular disease. Our audit studied a total of 71 patients in primary and secondary care in the greater London area with total Cholesterol levels greater than 7.5 mmols/l. In patients admitted to hospital (n=22); 27.8% patients were ITU admissions with 56% being under surgical team for acute pancreatitis. Only 45.4% of these patients were reviewed by the diabetes/endocrine team (most reviews being for management of diabetic ketoacidosis). 54.5% of patients were initiated and continued on insulin therapy (11% were on IV insulin only for management of hyperlipidaemia). 9% of patients had to have plasmapheresis. With regards to work up only 9% of these patients received lifestyle advice or screening for further co-morbidities. 45.5% were referred onwards to a lipid clinic. None of the acute admissions had inpatient investigations sent to screen for familial causes. Selected Patients attending GP practice (n=49) had an average total cholesterol level of 11.28 mmols/litre. About 70% of these patients received formal lifestyle advice. 18.3% of these patients were referred to a dietician. Around 77% of these patients were on statins and 67% of these patients were on two or more medications. 33.7% of these patients were diabetic and under follow up with Endocrine. 18.3% of these patients were classified as increased cholesterol secondary to alcohol use (it was unclear whether these patients were always referred to alcohol liaison services). Only 4% of these patients were referred to endocrine after screening for diabetes highlighting a significant gap in secondary screening. 34.7% of these patients underwent screening for familial hypocholesteraemia and were referred to a specialised lipid clinic. Our audit highlighted the gap in management of patients getting followed up in primary care vs being admitted in the hospital. The authors felt that dual guidelines emphasising on discharge based planning from hospital and a more secure safety net for patients with significant cardiovascular risk is needed. A GP guided approach with early referrals to lipid clinic/endocrine may achieve positive outcomes in such cases.