Excessive Repeat Lipid Testing Wastes Healthcare Resources

The experiences of clinical laboratory pathologists support the conclusion that as many as one-third of coronary heart disease (CHD) patients have unnecessary repeat lipid testing.

It is widely recognized within the laboratory medicine profession that many physicians regularly order inappropriate medical tests and that this has been a problem for decades and is the source of copious wasteful spending.

Scientists at the Veterans Affairs Medical Center (VAMC, Houston, TX, USA) identified 27,947 patients with CHD who were taking a variety of lipid-lowering medications and who had attained the guideline-recommended low-density lipoprotein (LDL) cholesterol target of less than 100 mg/dL. The mean age of these study subjects was 73 years, and most of the patients were white males. The prevalence of hypertension was 86%, and that of diabetes was 44%.

The study subjects had well-controlled lipid levels, with excellent mean baseline levels of LDL cholesterol of 70 mg/dL, non-high density lipoprotein (HDL) cholesterol of 94 mg/dL, triglycerides of 123 mg/dL, and HDL cholesterol of 43 mg/dL, and 72% were taking statins. A total of 9,200 underwent repeat lipid panels within 11 months, without any intensification of their treatment. This ruled out any patients who might have been attempting to reach an even lower LDL cholesterol target of less than 70 mg/dL.

A total of 34% of the repeat lipid tests were done within six months of an index test, and 80% were done within nine months. Their results were strikingly similar to those of the index lipid panels, which also argues against major medication or therapeutic lifestyle changes as the drivers of repeat lipid testing. A sensitivity analysis involving a subset of 13,114 patients who had optimal of below 70 mg/dL LDL levels, showed that 62% underwent repeat lipid testing, confirming that redundancy was commonplace even in these patients.

The study showed that patients with concomitant high blood pressure or diabetes as the most likely to undergo repeat lipid panels, although redundant testing is commonplace even in healthy patients. Salim S. Virani, MD, PhD, the senior author of the study, said, “There is a tendency of health care providers to order frequent laboratory testing in complex patients. Frequent lipid testing in these patients likely represents providers’ practice to order comprehensive laboratory tests, including lipid levels, rather than focusing on one clinical issue, for example, ordering only glycated hemoglobin (HbA1c) measurement to assess diabetes control.” The study was published online on August 12, 2013, in the journal JAMA Internal Medicine.

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