Prise en charge des patients dyslipidémiques : analyse des écarts entre le référentiel et la pratique dans un centre hospitalier

Abstract Objectives .– National guidelines for lipid management have been updated in March 2005 by the French Health Products Safety Agency (Afssaps). The objective of this study was to assess clinical practices based on these recommendations in a department of endocrinology specialized in the management of dyslipidemic patients. Materials and methods .– A sample of patients was independently selected among those referred to our outpatient clinic for assessment of hyperlipidemia. We analyzed retrospectively whether the management of dyslipidemia in these patients was consistent with national guidelines. Results .– We included 62 patients. At admission, 61% of patients had a lipid-lowering treatment that was consistent with the guidelines and a LDL-cholesterol value below the target level. At discharge, the lipid-lowering treatment was modified in 27% of patients. The changes were consistent with Afssaps guidelines in 79% of patients. Cases of non-compliance with the guidelines were explained by a lower threshold of LDL-cholesterol target in patients with carotid plaques and no changes because LDL-cholesterol was just above the LDL-cholesterol target. Conclusion.– Lipid management was consistent with Afssaps guidelines in a majority of patients. However, this study emphasized unresolved problems in lipid management, such as the question of integrating arterial status in the therapeutic decision.