Physicians' perception of guideline-recommended low-density lipoprotein target values: characteristics of misclassified patients

Sager, Hendrik B.; Linsel-Nitschke, Patrick; Mayer, BjÃ¶rn; Lieb, Wolfgang; Franzel, Brigitte; Elsasser, U; Schunkert, Heribert

doi:10.1093/eurheartj/ehq026

Cited by 19 publications

(22 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These have shown that noncompliance is as high as 70% and occurs across most disciplines and countries [2,[6][7][8][9]. One important aspect that has not been well studied is that of the age of practitioners.…”

Section: Not All Physicians Follow Guidelinesmentioning

confidence: 99%

Why are clinical practice guidelines not followed?

Barth

Misra

Aakre

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

144

View full text Add to dashboard Cite

Abstract:Clinical practice guidelines (CPG) are written with the aim of collating the most up to date information into a single document that will aid clinicians in providing the best practice for their patients. There is evidence to suggest that those clinicians who adhere to CPG deliver better outcomes for their patients. Why, therefore, are clinicians so poor at adhering to CPG? The main barriers include awareness, familiarity and agreement with the contents. Secondly, clinicians must feel that they have the skills and are therefore able to deliver on the CPG. Clinicians also need to be able to overcome the inertia of "normal practice" and understand the need for change. Thirdly, the goals of clinicians and patients are not always the same as each other (or the guidelines). Finally, there are a multitude of external barriers including equipment, space, educational materials, time, staff, and financial resource. In view of the considerable energy that has been placed on guidelines, there has been extensive research into their uptake. Laboratory medicine specialists are not immune from these barriers. Most CPG that include laboratory tests do not have sufficient detail for laboratories to provide any added value. However, where appropriate recommendations are made, then it appears that laboratory specialist express the same difficulties in compliance as front-line clinicians.

show abstract

Section: Not All Physicians Follow Guidelinesmentioning

confidence: 99%

Why are clinical practice guidelines not followed?

Barth

Misra

Aakre

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

144

View full text Add to dashboard Cite

show abstract

“…First, physicians may underestimate the individual risk to their patient. Sager et al19 used logistic regression to analyze whether 907 primary care physicians utilized risk factors and comorbidities appropriately for the assignment of correct LDL-C target values. They found that overall, physicians estimated recommended LDL-C target values correctly in only about half of their 25,000 patients (55.1% of male vs 49.1% of female patients); poor perception of CV risk resulted in lower rates of objective LDL-C target achievement.…”

Section: Discussionmentioning

confidence: 99%

Lipid management in 13,000 high risk cardiovascular patients treated under daily practice conditions: LIMA Registry

Schaefer¹,

Gitt²,

Sonntag³

et al. 2013

VHRM

View full text Add to dashboard Cite

AimsWe aimed to document the drug management of patients at high cardiovascular risk in daily practice, with the special focus on lipid-lowering treatment.Methods and resultsIn this prospective noninterventional study in 2387 outpatient centers throughout Germany, a total of 13,942 high-risk patients (mean age 65.7 years, 61.6% males) were treated with simvastatin 40 mg/day at entry as monotherapy. All patients were followed up for 12 months in terms of drug utilization, laboratory values, target attainment, and clinical events (including death, hospitalization, vascular events, and dialysis). Patients had coronary heart disease in 35.0%, diabetes mellitus in 24.4%, and the combination of coronary heart disease plus diabetes mellitus in 25.7%. In 21% of patients, a cholesterol absorption inhibitor was added to statin therapy at the entry visit, and in 23%, this was added at the follow up visit 6 months later. The target values for low-density lipoprotein-cholesterol (<2.6 mmol/L) were reached by 31.8% of patients at entry and by 50.0% at the end of this registry after 12 months. Mean blood pressure decreased (from 135.9/80.5 mmHg at baseline) by 3.1/1.9 mmHg after 12 months. In patients with documented diabetes, the targeted glycated hemoglobin (HbA1c <6.5%) was reached by 33.5% at baseline and by 40.0% after 12 months. Clinical events occurred in 11.7% of patients between baseline and month 6, and in 12.0% between months 6 and 12.ConclusionIn patients at high risk for cardiovascular events, comprehensive management under daily practice conditions leads to improvement of lipid, glucose, and blood pressure parameters. There is a need to improve secondary prevention among high-risk patients.

show abstract

“…European guidelines were first published in 1994 167 and thereafter updated about every four years 3,130,168,169 In primary prevention, the proportion of high-risk individuals with elevated blood lipids treated with lipid-lowering drugs varies widely between countries, from about half to three quarters 8,20,[178][179][180][181] . However, less than half of the treated patients reach the total cholesterol reduction recommended by the guidelines [182][183][184] , 28% in Italy, and from 29% to 48% in Sweden 8,185 . Suboptimal treatment is associated with less reduction of cardiac events 186 .…”

Section: Guidelines On Lipid-lowering Treatmentmentioning

confidence: 98%

“…An international European study showed that the incidence rate of cardiovascular events during three years of observation was more than double in individuals who did not reach the LDL cholesterol reduction target compared to those at target 185 . The presence of co-morbidities and also being female seem to reduce appropriate lipid-lowering treatment 23,182 . Conversely, an overuse of statins has been documented in low-risk individuals with low expected benefits 19,20 .…”

Section: Guidelines On Lipid-lowering Treatmentmentioning

confidence: 99%