Statin prescribing and cardiovascular events in stage 3-4 CKD patients at a tertiary teaching hospital following the publication of the 2017 NICE guidance on statins in CKD

Dr. G Gentile, Dr. E Khine, Dr. H Morgan, Dr. E Mcdermott, Dr. A Williamson, Dr. V Manfreda, Dr. M Fadlallah.

Background

CKD affects 700 million people worldwide and increases the risk of cardiovascular (CV) morbidity and mortality due to traditional and novel CV risk factors (albuminuria, mineral bone disease). Most people with CKD die for CV disease rather than progressing to stage 5. NICE 2017 guidelines recommended patients with eGFR <60ml/min/1.73m2 should be on a statin for CV disease prevention.

Results

Patients were mostly males with a median age of 73.4. Baseline prevalence of current/ex- smokers, previous CV events, diabetes, and hypertension was 28.4, 46.7, 50.1, and 78.7% respectively, suggesting a population at very high risk of CV events.

58% were on a statin at baseline, this raised to 62, 68.3 and 69.4% at 1, 2 and 3 years, respectively. However, most patients were on a statin for secondary prevention of CV disease. Adherence to NICE guidance in primary prevention was low (42.5%) and did not significantly improve during follow-up.

Methods

A retrospective observational study including 150 renal out-patients with stage 3-4 CKD at RCHT between July 2017 (date of NICE publication) and 2022. Data were extracted from electronic databases and GP summaries. Anagraphic, disease (diabetes, hypertension, etc.), laboratory, and drug data were extracted. Statin prescribing was recorded at baseline and 1, 2 and 3 years of specialist review.

Conclusions

Statin prescribing in CKD out-patients needs improvement, almost 60% didn’t receive a statin as per NICE guidance. A stronger collaboration with primary care is imperative to achieve the target, as nephrologists see the patient too late, at which time almost half of patients have already had a CV event.

Sarah J. Puthur1 , Haroon, Majeed2

Foundation Trust;

• High calibre post-operative notes are necessary in Trauma and Orthopaedics departments to facilitate effective communication between colleagues 1 .

• The guidelines provided by the Royal College of Surgeons of England (RCS Eng) is widely used for writing comprehensive post-operative notes 2

• The generic nature of the above guidelines omits specific post-operative information in operation notes such as weight bearing status, requirement for post-operative physiotherapy, requirement for antibiotic prophylaxis, venous thromboembolism (VTE) prophylaxis and appropriate follow-up plan which are crucial for delivering high quality care in Trauma and Orthopaedics 3 4

Lessons Learnt

Trust

To review quality of post-operative documentation in operation notes within the Trauma and Orthopedics department at a level 1 trauma center and assess if a standard proforma improved documentation

Methods

Results

Weightbearingstatus

Post-operativeinstructionsfor physiotherapy Appropriatefollowuporganized

Following introduction of standard proforma at the emergency site, statistically significant improvement in documentation of: oRequirement for post-operative physiotherapy (P= 0.001)

Following introduction of standard proforma at the elective site, statistically significant improvement in documentation of: oRequirement for post-operative antibiotic prophylaxis (P= 0 009) oRequirement for VTE prophylaxis (P= 0 001) oRequirement for post-operative physiotherapy (P= 0 001)

However, no statistically significant improvement in documentation of: o Weight bearing status post operation o Need for post operation follow up ANTICIPATED BENEFITS OF BETTER DOCUMENTATION IN ORTHOPEDICS

Customize the standard proforma currently in use to include specific post-instructions:

1. Requirement for antibiotic prophylaxis

2. Requirement for VTE prophylaxis

3. Weight bearing status and duration

4. Requirement for post-operative physiotherapy

5. Follow up

References

Peri-operativecomplicationsApproximatebloodloss

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Detailsofclosure

Requirementfor post-operativeantibioticprophylaxis

RequirementforVTEprophylaxis

Post-operativenursinginstructions

Next Steps

Weightbearingstatus

Post-operativeinstructionsfor physiotherapy

Appropriatefollowuporganized