Can Physician Education and Support Improve Patient Management

Langer, Anatoly; Tan, M. J.; Bell, Alan; Ngui, Daniel; Mah, Douglas Y.; Mehan, Upender; Noronha, Lionel; Goldin, Lianne; Leiter, Lawrence A.

doi:10.33425/2639-8486.1084

Cited by 2 publications

(1 citation statement)

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“…Recent experience [12][13][14] indicated three different but interconnected levels of care gap; absence of cholesterol panel results on the chart in approximately 50% of patients, use of guideline recommended lipid lowering therapy in only a minority of patients and lowering of the LDL-C or non-HDL-C to recommended levels in approximately a third of patients with ASCVD. We, therefore, studied whether physician focussed, guideline-based patient level educational intervention can improve lipid lowering management as part of this international quality improvement (QI) program with educational intervention based on feedback to physicians on their management of dyslipidemia to support their decision making and choice of therapy in order to more optimally achieve guideline-recommended LDL-C level in ASCVD patients [2].…”

Section: Introductionmentioning

confidence: 99%

Guidelines Oriented Approach to Lipid (GOAL) Lowering Quality Improvement International Program

et al. 2023

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Background: Despite practice guidelines, strategies for lowering LDL-C are often poorly adopted in clinical practice. Materials and Methods: Five countries (Brazil, Kuwait, Mexico, Saudi Arabia, and UAE) enrolled 2,422 patients with atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia (FH) with low density lipoprotein cholesterol level (LDL-C) above 1.4 mmol/L. Patients were followed at 6 ± 2 months intervals to assess LDL-C level and treatment with ezetimibe and/or proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i). Results: 2422 patients 60.4 ± 11.7 years old and 29% women were enrolled from 87 participating cardiology sites. Overall, 91.1% of patients had coronary artery disease and FH in 12.3%. At baseline LDL-C was 2.96 ± 1.36 mmol/L and 1.87 ± 1.28 mmol/L (p<0.0001) at last available observation (n=2014). Proportion of patients achieving LDL<1.4 mmol/L (primary endpoint) increased from zero to 41.4% (p<0.0001). At baseline, 99.2% of patients were on statin (81.3% high intensity statin), 34.4% on ezetimibe and its use increased significantly (62.9%, p<0.0001). PCSK9i use increased to 35.0% from baseline to last follow up (p<0.0001). Clinical outcomes such as ACS, CVA/TIA, PCI, CABG, or hospitalization for ASCVD reasons were recorded in 10.7% of patients during the follow up. Patients with no event had an overall LDL-C of 1.90 ± 1.3 mmol/L while those with an event had LDL-C significantly higher at the visit immediately prior to event (2.70 ± 1.35, p=0.0001). Conclusion: The results indicate the feasibility of overcoming treatment inertia and improving LDL-C control which should help to achieve reduction in cardiovascular morbidity and mortality in ASCVD patients.

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