The one-stop coronary cholesterol clinic: a multidisciplinary approach to implementing evidence-based treatment

Giles, Paul; Ramachandran, Selvakumar; Whitaker, Anne; Phillips, Alexander W; Fell, S. J.; Mitchell, Aaron P.; Coleman, T. D.

doi:10.1136/pgmj.72.854.744

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…Statins block hepatic cholesterol synthesis leading to upregulation of LDL receptors and increase in LDL particle uptake, thereby lowering serum LDL-c and TC. The evidence from 4S prompted us to move away from TC reference ranges and adopt an action limit of below 5.2 mmol/l for the coronary cholesterol clinic treating secondary prevention patients in the Manor Hospital, Walsall [11]. The significant CVD risk reduction observed in 4S was replicated in many other intervention trial studies [12][13][14][15][16][17][18].…”

Section: Low Density Lipoprotein-cholesterol and Cardiovascular Diseasementioning

confidence: 99%

Managing Clinical Heterogeneity: An Argument for Benefit-Based Action Limits

Ramachandran

König

Hackett

et al. 2018

Journal of Engineering and Science in Medical Diagnostics and Therapy

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The use of reference ranges is well established in medical practice and research. Classically, a range would be derived from the local healthy population and matched in age, gender, and other characteristics to the patients under investigation. However, recruiting suitable controls is problematic and the derivation of the range by excluding 2.5% at each end of the distribution results in 5% of the values being arbitrarily discarded. Thus, the traditional reference range is derived using statistical and not clinical principles. While these considerations are recognized by clinicians, it is often not realized that the application of whole population derived reference ranges to complex pathologies that comprise patient subgroups may be problematic. Such subgroups may be identified by phenotypes including genetic etiology, variations in exposure to a causative agent, and tumor site. In this review, we provide examples of how subgroups can be identified in diverse pathologies and how better management can be achieved using evidence-based action limits rather than reference ranges. We give examples from our clinical experience of problems arising from using the wrong reference ranges for the clinical situation. Identifying subgroups will often enable clinicians to derive specific action limits for treatment that will lead to customized management and researchers a route into the study of complex pathologies.

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Section: Low Density Lipoprotein-cholesterol and Cardiovascular Diseasementioning

confidence: 99%

Managing Clinical Heterogeneity: An Argument for Benefit-Based Action Limits

Ramachandran

König

Hackett

et al. 2018

Journal of Engineering and Science in Medical Diagnostics and Therapy

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Cholesterol reduction for the secondary prevention of coronary heart disease: a successful multi‐disciplinary approach to implementing evidence‐based treatment in a district general hospital

Giles

Cunnington

Payne

et al. 1998

Journal of Clinical Effectiveness

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The Walsall clinic for survivors of myocardial infarction is described. Coronary heart disease is a major health issue in Walsall. The starting point for the project was the publication of the Scandinavian Simvastatin Survival Study (4S) in 1994, which showed the benefit of cholesterol treatment in these patients. Although the new clinic was established primarily to implement a 4S‐based regime, the cholesterol regime has been modified in the light of newer evidence, and the service broadened to encompass cardiological assessment and the use of other forms of secondary prevention. Several factors have contributed to the success of the service, including support from the Health Authority, patient involvement, partnership with Primary Care and the use of information technology. The latter has integrated routine clinical record keeping and correspondence with complete prospective audit data accumulation and measurement of performance against evidence‐based standards. These principles are of potential value in other clinical effectiveness initiatives.

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The one-stop coronary cholesterol clinic: a multidisciplinary approach to implementing evidence-based treatment

Cited by 2 publications

References 12 publications

Managing Clinical Heterogeneity: An Argument for Benefit-Based Action Limits

Managing Clinical Heterogeneity: An Argument for Benefit-Based Action Limits

Cholesterol reduction for the secondary prevention of coronary heart disease: a successful multi‐disciplinary approach to implementing evidence‐based treatment in a district general hospital

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