European Physician Survey Characterizing the Clinical Pathway and Treatment Patterns of Patients Post-Myocardial Infarction

Abstract

Introduction:The 2019 European Society of Cardiology and European Atherosclerosis Society (2019 ESC/EAS) guidelines stress the importance of managing low-density lipoprotein cholesterol (LDL-C) after myocardial infarction (MI) to reduce the risk of cardiovascular events. Information on guideline implementation is limited. The aim of this survey was to describe current clinical practice regarding LDL-C management in the first year post-MI across Europe, improving understanding of the role of ESC/EAS guidelines on clinical practice. Methods: A qualitative web-based cross-sectional physician survey about the patient pathway and LDL-C management post-MI was conducted in 360 physicians from France, Italy, Germany, The Netherlands, Spain, and the UK (n = 60/country) between December 2019 and June 2020. Secondary and primary care physicians (SCPs/PCPs) described their experiences treating patients post-MI over the preceding 2 months. Results: Physicians reported that on average 90.7% of patients not prescribed lipid-lowering therapy (LLT) before an MI initiated LLT as inpatients; for patients already taking LLT, treatment was intensified for 64.7% of inpatients post-MI. SCPs reported prescribing higher-intensity statins and/or ezetimibe for between 72.3% (Italy) and 88.6% (UK) of patients post-MI. More than 80.0% of SCPs and 51.2% of PCPs stated that they would initiate a change in LLT immediately if patients did not achieve their LDL-C treatment goal by 12 weeks post-MI; 82.0% of SCPs and 55.1% of

Missed Opportunities in Implementation and Optimization of Lipid-Lowering Therapies in Very-High-Risk Patients Presenting with ST-Segment Elevation Myocardial Infarction

“…The heterogenous inclusion of registry patients may account for the discrepancy in findings among Da Vinci cohorts but, overall, the take-home message of inadequate LLT implementation and optimization, as well as low LDL-C target attainment among these registry patients remains the same. A multi-center European study of a physician survey characterizing LLT treatment patterns also showed low levels of therapy intensification, mirroring our results, yet variances in prescribing practices depending upon regions [18].…”

Short-Course High-Intensity Statin Treatment during Admission for Myocardial Infarction and LDL-Cholesterol Reduction—Impact on Tailored Lipid-Lowering Therapy at Discharge

“…Even if a patient is not included in a Cardiac Rehabilitation Program after MI, a blood test should be drawn, and a follow-up visit should be scheduled 4 to 6 weeks after hospital discharge, with subsequent LLT optimization if lipidic targets are not reached [ 7 , 15 , 44 ]. However, real-life registries show that the rate of lipid testing after MI is disappointingly low in many countries, and, when performed, it is usually obtained 3 or more months after hospital discharge [ 45 , 46 ].…”