Adherence to Blood Cholesterol Treatment Guidelines Among Physicians Managing Patients With Atherosclerotic Cardiovascular Disease

Abstract

The ACC/AHA blood cholesterol treatment guidelines recommend statin therapy for all patients after experiencing an acute cardiovascular event. Previous analyses have shown that physicians have been slow to adopt guidelines, and many patients remain untreated or undertreated with statins after a cardiovascular event. However, reasons for this remain unknown. This analysis used electronic medical records and patient chart data from Reliant Medical Group (Worcester, Massachusetts) to evaluate physician adherence to the 2013 ACC/AHA blood cholesterol guidelines when treating patients with evidence of acute atherosclerotic cardiovascular disease and the reasons for the observed treatment decisions. Less than 50% of acute atherosclerotic cardiovascular disease patients were treated according to the ACC/AHA guidelines. Nearly 42% of patients not treated according to guidelines received a lower statin intensity than recommended. The most common reason cited by 41.8% of physicians for treating with a statin intensity below the recommended intensity was low-density lipoprotein cholesterol stable or at goal, despite ACC/AHA guidelines recommending specific statin intensities rather than specific low-density lipoprotein cholesterol levels. In conclusion, physician and patient education on the importance of maximizing lipidlowering therapy in this high-risk patient population should be emphasized.

Adherence to Current Lipid Guidelines by Physicians in Kuwait

“…Furthermore, despite frequent application of lipid guidelines by cardiologists, diabetologists, endocrinologists, and clinical biochemists, there was an apparent discrepancy in the total familiarity score calculated among these specialties. These findings are comparable to a study conducted in the USA which also found a gap between knowledge and practice, and emphasized the importance of education [16]. Instances such as these may benefit from continuing medical education through lectures, workshops, and conferences, which can lead to better health outcomes [17].…”

“…It is noteworthy that using a combination of lipid guidelines can in fact lead to misinterpretation and ineffective or inadequate treatment as a result of both knowledge and behavior barriers. Once again, these issues can be addressed with reeducation, e.g., academic sessions [16, 17].…”

Low‐density lipoprotein cholesterol lowering in real‐world patients treated with evolocumab

“…However, observational studies indicate that patients infrequently achieve these guideline‐recommended LDL‐C goals in daily clinical practice, 17‐21 with a recent analysis of US adults with health insurance in the MarketScan ® database reporting that 67% of patients with VHR ASCVD had LDL‐C ≥ 70 mg/dL (≥ 1.8 mmol/L) 21 . Multiple factors are thought to underpin this unmet treatment need, with suboptimal dosing, high rates of treatment discontinuation, and low rates of lipid‐lowering therapy (LLT) adherence commonly observed 22‐27 …”

“…Within the context of personalized medicine, these data suggest that it is reasonable to target evolocumab therapy to higher‐risk patients following a recent MI 12,29 . However, there are limited data on LDL‐C lowering with evolocumab in real‐world healthcare settings, where patient‐, physician‐, and payer‐related treatment hurdles are common 17,22‐27,30‐33 . Historically, these hurdles have included treatment discontinuation, educational needs for providers, prior authorization requirements, costs, and formulary restrictions 30‐33 …”

“…21 Multiple factors are thought to underpin this unmet treatment need, with suboptimal dosing, high rates of treatment discontinuation, and low rates of lipid-lowering therapy (LLT) adherence commonly observed. [22][23][24][25][26][27] Evolocumab is a PCSK9 inhibitor antibody approved to reduce the risk of MI, stroke, and coronary revascularization in adults with established CVD. 28 The efficacy of evolocumab is well established from clinical trials, with significant lowering of LDL-C and reduction of major CV events.…”