- Reducing liver function tests for statin monitoring
I was very pleased to read Homer et al’s paper on reducing liver function tests for statin monitoring.1 Over-testing involves cost, may lead to unnecessary further investigation, consumes clinical time and leads to patient anxiety.
LFTs may have become a ‘routine’ investigation in primary care,2 sometimes performed when a patient has non-specific symptoms and no particular pointers to liver disease. In the ALFIE study a large cohort of patients with incident LFT testing in primary care was followed up for the development of liver disease2. Of patients tested 21.7% had at least one abnormal liver function result in a routine LFT test battery while only 1.14% developed liver disease during follow up. This finding was backed up in the BALLETS study3 where fewer than 5% of people with abnormal LFT results in primary care were found to have a specific disease of the liver.
The British Society for Gastroenterology is preparing guidance on when to test LFTs and how to interpret the results. The guidelines should be published later this year.
The RCGP Liver Disease Clinical Priority Programme has been created to support the management of liver disease in primary care, and will publicise these guidelines when they are published on its resource page (www.rcgp.org.uk/cl...Competing Interests: None declared.
- E: Statins and the need to reduce testing
In clinical practice and conform QOF guidelines, it is still common practice to do a full biochemical profile as well as full lipids, despite NICE guidelines suggesting that once a patient is on maximal tolerated statins further lipid testing is not necessary.
In 2011 I have a comment published in The Lancet, stating something similar, routine testing is not of any benefit.1
The cost savings suggested in this article are immense, if you take into account the time it takes for a receptionist to make the appointment, the health care assistance taken a blood sample, the transport costs to take it to the lab, the lab to process and report it and for the GP to file it, time and time again normal blood test results and then to see them back in the clinic for no other reason.
This article perfectly support this argument. It is now how to make this actually work in working practice.
1. de Vries, H. Raised liver enzymes in patients taking statins. The Lancet 2011; 377(9771) 1075.Competing Interests: None declared.