Do not routinely test and treat hyperlipidemia in those with a limited life expectancy.
Measurement of lipid levels is part of absolute risk assessment for the prevention of cardiovascular disease. Age is a predominant risk factor in the elderly, so absolute risk calculators accommodate this by fixing 75 years as the maximum age that can be included in the calculation. Clinicians need to consider whether or not the assessment and treatment of risk factors beyond this age in the very elderly is likely to yield clinical benefit within the patient’s remaining life expectancy. On rare occasions lipid testing may provide relevant information in other life threatening diseases, such as pancreatitis, but in most critical illnesses lipid measurement for prevention of chronic disease will no longer be a priority.
- National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. 2012.
A list of ten items was compiled after reviewing international literature associated with the Choosing Wisely campaign in Northern America. The College’s advisory committees were canvassed for further relevant evidence based literature and their expert opinions were sought.
The ten items were then adopted as a College Position Statement titled ‘Inappropriate Pathology Requesting’. This list was then sent to RCPA Fellows and Trainees based in Australia to rank the top five tests to include in the Australian Choosing Wisely initiative. The five items selected were approved by both the RCPA's Board of Professional Practice and Quality and the RCPA Board of Directors.
- 1 Do not perform surveillance urine cultures or treat bacteriuria in elderly patients in the absence of symptoms or signs of infection.
- 2 Do not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 7 years.
- 3 Do not perform population based screening for Vitamin D deficiency.
- 4 Restrict the use of serum tumour marker tests to the monitoring of a cancer known to produce these markers or where there is a strong known underlying predisposition or suspicion.
- 5 Do not routinely test and treat hyperlipidemia in those with a limited life expectancy.