Felice Gragnano, Chiara Artana, Greta Carrara, Alice Sacco, Claudio Montalto, Marco Mennuni, Marco Zuin, Fabrizio D’Ascenzo, Fabrizio Del Nevo, Vincenzo De Sio, Leonardo De Luca, Giulia Spoto, Giuseppe Musumeci, Fabrizio Oliva, Gaetano Maria De Ferrari, Daniele Grosseto, Paolo Calabrò, Giuseppe Patti, Gianluca Campo, S Leonardi, Danilo Lisi, Arturo Cesaro, Vincenzo Acerbo, Antonio Capolongo, Antonia Ascrizzi, Giuseppe Verde, Michelangelo Luciani, Gabriele Cappiello, Natale Guarnaccia, Pasquale Maddaluna, Maria Grazia Monaco, Licia Petrillo, Luisa Di Donato, Monica Portolan, Daniele Cucchi, Rossana Totaro
Background Actionable quality gaps persist in low-density lipoprotein cholesterol (LDL-C) management after acute myocardial infarction (AMI). We aimed to quantify diagnostic and therapeutic inertia in LDL-C management after discharge in a real-world AMI population with verified and quantified consecutive inclusion. Methods We conducted a quality improvement audit of patients discharged alive with a primary diagnosis of AMI. Consecutiveness was quantified using the consecutive index (e.g., the ratio of included patients with available 6-month follow-up information to the total AMI discharges). Diagnostic inertia was defined as no evidence of LDL-C measurement post-discharge. Therapeutic inertia was defined as LDL-C ≥ 55 mg/dL in the absence of optimal lipid-lowering therapy among patients with at least one post-discharge LDL-C measurement. A multivariable model was developed to identify risk-adjusted probability of LDL-C target achievement at follow-up. Results Among 3490 AMI patients, 3130 had at least a follow-up assessment after discharge. At six months, 2603 patients had available information on vital status, follow-up assessment, and post-discharge LDL-C assessment status (consecutive index: 74.6% [95% CI: 73.1–76.0%]). Diagnostic inertia occurred in 19.3% (95% CI: 17.8–20.9%) and therapeutic inertia in 38.1% (95% CI: 35.7–40.6%). In a multivariable model, the explained variance was modest (R 2 =14.4%; 95% CI: 12.0–18.2%). Conclusions In a contemporary cohort including approximately 75% of patients surviving hospitalization for AMI, one in five patients did not undergo LDL-C testing during follow-up and two in five did not receive adequate lipid-lowering therapy despite failing to reach guideline-recommended targets. These findings highlight a substantial opportunity for structured quality improvement initiatives targeting LDL-C management after AMI.