Lady Reading Hospital

Introduction Achieving optimal low-density lipoprotein cholesterol (LDL-C) reduction in high-risk patients remains a challenge, even with combination lipid-lowering therapy. This study evaluated LDL-C target attainment (≤70 mg/dL per European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2019 guidelines) in high-risk patients receiving statin plus ezetimibe therapy at a single tertiary care center in Peshawar, Pakistan. Methodology A retrospective analysis of a cross-sectional dataset was conducted at Hayatabad Medical Complex (HMC) over 12 months. A total of 123 high-risk patients, as defined by ESC/EAS 2019 criteria, who had been on statin plus ezetimibe therapy for a minimum of three months (mean duration: 4.2 ± 1.1 months), were included. LDL-C levels were recorded at a single post-treatment follow-up time point. Paired t-tests were used to assess LDL-C changes, and chi-square tests along with multivariable logistic regression were employed to identify predictors of target attainment. Results Mean LDL-C decreased significantly from 156.3 ± 32.5 mg/dL to 84.7 ± 24.1 mg/dL (mean reduction: 71.6 mg/dL; 95% CI: 66.8-76.4; p < 0.001). Overall, 53 of 123 patients (43.1%; 95% CI: 34.6-51.8%) achieved the LDL-C target. Target attainment was lower among diabetic patients (24 of 71; 33.8%) and smokers (13 of 39; 33.3%). In multivariable analysis, diabetes (aOR: 0.52; 95% CI: 0.28-0.97) and smoking (aOR: 0.55; 95% CI: 0.27-0.98) were independently associated with lower target attainment. High-intensity statin use was positively associated with achieving LDL-C goals (33 of 68; 48.5%; aOR: 1.89; 95% CI: 1.02-3.49). Conclusion This single-center study highlights that despite combination therapy, more than half of high-risk patients failed to achieve LDL-C targets. The findings underscore the need for more individualized strategies, improved adherence, and possibly adjunctive therapies. Although the data are from a single center in Peshawar, the trends reflect common challenges in real-world lipid management across similar low- to middle-income healthcare settings.

The main aim of this study is to know the loopholes in the feedback system, strategies to remove these loopholes, and to measure the effects of an efficient feedback system in an institution.

This research has three stages. In the first stage, we tried to find out the flaws in the feedback system of the institution based on published benchmarks. Then we tried to remove these flaws with the collaboration of different stakeholders. In the last stage of the study, we tried to measure the effectiveness of these corrective procedures by certain key performance indicators (KPIs).

After improvement strategies, there was a significant improvement in the KPIs like, the knowledge and attitude toward the feedback improved from 3.1 to 4.23 in students, and from 3.46 to 4.34 in faculty members, on a five-point scale, and the teaching standards improved as measured by students' performance in different courses in terms of learning objectives achievement, for example in internal medicine from 70.8% to 75.3%. Similar improvement was recorded in other KPIs as well.

An efficient feedback system is the backbone of education and by adopting effective feedback, individuals and institutions can excel in the field of medical education.