Physician Noncompliance With the 1993 National Cholesterol Education Program (NCEP-ATPII) Guidelines

Abstract

Background-We sought to determine the frequency with which physicians follow National Cholesterol Education Program (NCEP-ATPII) guidelines in screening for cardiovascular risk factors and treating hyperlipidemia. Methods and Results-We conducted a retrospective chart review on randomly sampled charts of 225 patients admitted to the coronary care unit between January and June 1996. The main outcome measures were rates of physician screening for coronary heart disease risk factors; rates of counseling for cigarette cessation, diet, and exercise; and extent of use of NCEP algorithms for obtaining LDL cholesterol values and treating hypercholesterolemia. Screening rates for interns (who performed best) were: cigarette use (89%), known coronary heart disease (74%), hypertension (68%), hyperlipidemia (59%), family history (56%), diabetes (37%), postmenopausal hormone therapy (11%), and premature menopause (1%). Four percent of smokers were counseled to quit, 14% of patients were referred to dietitians, and 1% were encouraged to exercise. A full lipid panel was obtained in 50% of patients in whom it was indicated on the basis of NCEP criteria. Patients were more likely to receive lipid-lowering treatment if NCEP criteria indicated that they should, but 36% of hospitalized patients and 46% of patients who should have been treated on discharge were not. Conclusions-Physicians are poorly compliant with NCEP guidelines for risk factor assessment and counseling, even in patients at high risk for coronary heart disease. Physicians follow NCEP-ATPII algorithms for obtaining an LDL value, a key step in evaluating the need for treatment, only 50% of the time. NCEP criteria seem to influence the decision to initiate lipid-lowering therapy, but significant numbers of eligible patients remain untreated. (Circulation. 1998;98:851-855.)

Physician Advice, Patient Actions, and Health-Related Quality of Life in Secondary Prevention of Stroke Through Diet and Exercise

“…5 Dietary therapy for stroke patients includes adoption of the American Heart Association Step II diet (with 30% of calories derived from fat and Ͻ7% derived from saturated fat and with Ͻ200 mg/d cholesterol consumed). 5 As in other studies, [11][12][13][14][15][16] the present results suggest that preventive counseling by providers is low. In the BRFSS, reported receipt of provider advice was greater among those with than without stroke, suggesting that preventive counseling is directed to high-risk patients.…”

Opportunity for Intervention to Achieve American Heart Association Guidelines for Optimal Lipid Levels in High-Risk Women in a Managed Care Setting

“…8 Consistent with previous literature, our study reported that only 1 of 3 patients received lipidlowering medication. [15][16][17][18] These data suggest that there is a significant treatment gap in high-risk women. Similar to our analyses, previous studies have reported that goal attainment in individual and combined lipid levels are associated with use of lipid-lowering medications.…”

Statin treatment and adherence to national cholesterol guidelines after ischemic stroke

“…Numerous studies of individuals with cardiac disease have implied that appropriate treatment of cholesterol levels has been suboptimal. [13][14][15][16][17] This study suggests that the same may be true for patients with ischemic stroke at high vascular risk.…”