Provider understanding of the 2013 ACC/AHA cholesterol guideline

Virani, Salim S.; Pokharel, Yashashwi; Steinberg, Lynne; Chan, Winston; Akeroyd, Julia M.; Gowani, Saqib Ali; Kalra, Ankur; Polsani, Venkateshwar; Miedema, Michael D.; Jones, Peter H.; Nambi, Vijay; Petersen, Laura A.; Ballantyne, Christie M.

doi:10.1016/j.jacl.2015.11.002

Cited by 62 publications

(58 citation statements)

References 29 publications

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“…There is some evidence that a majority of practitioners are not conducting follow‐up testing of LDL‐C levels 9. We found similar rates between the pre‐ and postguidelines frequency of LDL tests (1.2 LDL‐C orders per patient in the 2–7 months of follow‐up both before and after the guidelines).…”

Section: Discussionsupporting

confidence: 62%

“…It is possible that a lack of treatment goals in the guidelines is leading to confusion and a decreased focus on reducing levels of atherogenic lipids. This study and others surveying physician prescribing practices before and after the guidelines suggests a knowledge gap that may be limiting statin prescribing changes 9. In addition, new lipid‐lowering therapies, such as PCSK9 inhibitors, are currently in use.…”

Section: Discussionmentioning

confidence: 85%

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Effect of 2013 ACC/AHA Blood Cholesterol Guidelines on Statin Treatment Patterns and Low‐Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Patients

Okerson

Patel

DiMario

et al. 2017

JAHA

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BackgroundPreceding release of the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guidelines, prescribers aimed for specific low‐density lipoprotein cholesterol (LDL‐C) goals in patients with atherosclerotic cardiovascular disease (ASCVD). The 2013 guidelines changed this focus to treating patients with appropriate statin intensity given their ASCVD risk. We examined statin use and LDL‐C levels before and after the 2013 ACC/AHA guidelines in patients with clinical ASCVD as defined in the guidelines.Methods and ResultsWe conducted a retrospective cohort study of adult commercial and Medicare Advantage health plan enrollees in the Optum Research Database. Patients had ≥1 claim with a diagnosis of clinical ASCVD between November 1, 2012 and December 31, 2014 and were continuously enrolled 6 months before (baseline) and 7 months after (follow‐up) the first ASCVD visit. Patients were assigned to monthly cohorts based on ASCVD event month. Statin use and intensity were measured at baseline and first month of follow‐up. LDL‐C changes were assessed using ordinary least squares regression. For 90 287 patients, mean (SD) age was 68 (12) years; 50% were female; and 30% had commercial insurance. Statin use remained consistent before and after guidelines (32% and 31%, respectively). Of patients receiving statins, high‐intensity use increased by 4 percentage points 1 year after guidelines (P<0.001). Mean LDL‐C levels were 2.4 mmol/L (94 mg/dL) both pre‐ and postguidelines.ConclusionsStatin use and mean monthly LDL‐C before and after the guidelines remained largely unchanged; statin intensity increased modestly. More effort may be needed to increase guideline understanding and adherence to improve treatment of high‐risk patients.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 85%

Effect of 2013 ACC/AHA Blood Cholesterol Guidelines on Statin Treatment Patterns and Low‐Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Patients

Okerson

Patel

DiMario

et al. 2017

JAHA

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“…4 Statin therapy in real world practice has been suboptimal, 11–13 with one of the important reasons related to gaps in providers’ knowledge and attitudes towards the 2013 cholesterol guideline. 14,15 A previous study found that providers have suboptimal knowledge on most knowledge items related to the new cholesterol guideline. 15 Therefore, the purpose of the current study was to assess whether a case-based educational intervention, using a conceptual framework, 16 primarily targeting provider-level gaps, could improve providers’ knowledge and attitudes towards the 2013 ACC/AHA guideline on the treatment of blood cholesterol.…”

Section: Introductionmentioning

confidence: 99%

Case-based educational intervention to assess change in providers' knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

et al. 2016

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Objective Prior studies have shown provider-level knowledge gaps regarding the 2013 American College of Cardiology/American Heart Association guideline on the treatment of cholesterol and concerns about 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation. The effect of an educational intervention to mitigate knowledge gaps is unknown. Methods We developed a questionnaire and administered it to providers before (pre-training) and after (post-training) a case-based educational intervention across 6 sites in Texas. The intervention highlighted the key recommendations of the 2013 guideline and the differences from the prior guideline mainly using clinical-vignettes. Several practice pertinent items were also discussed. Results Most participants were providers-in-training (78%) in internal medicine (68%). Compared to pre-training, the post-training metrics were: 43% vs. 82% for providers’ ability to identify 4 statin benefit groups; 47% vs. 97% for their awareness of the ASCVD risk threshold of ≥7.5% to initiate discussion about risks/benefits of statin therapy; 9% vs. 40% for awareness of differences between the Framingham and the ASCVD risk estimator; 26% vs. 78% for awareness of the definition of statin intensity; 35% vs. 62% for using a repeat lipid panel to document treatment response and adherence; and 46% vs. 81% for confidence in using the ASCVD risk estimator, respectively. Conclusions A case-based educational intervention was associated with significant improvements in providers’ knowledge and attitudes towards the 2013 cholesterol guideline, which could be related to the engaging nature of our intervention, using practice pertinent information and clinical vignettes. Such interventions could be useful in effective dissemination of the cholesterol guideline.

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“…Recommendations for LDL‐C testing remain in these guidelines to screen for familial hypercholesterolemia, determine response to statin therapy, and assess adherence. Prior studies demonstrated a misconception that clinicians following the 2013 ACC/AHA guidelines no longer needed to measure lipid levels given the shift away from LDL‐C treatment targets 12, 13. Our study showed that many primary and secondary prevention patients were managed without recent LDL‐C testing, which may be a reflection of misinterpretation of the 2013 ACC/AHA guidelines.…”

Section: Discussionmentioning

confidence: 75%

Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry

Lowenstern

Návar

et al. 2018

JAHA

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BackgroundThe 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommended testing low‐density lipoprotein cholesterol (LDL‐C) to identify untreated patients with LDL‐C ≥190 mg/dL, assess lipid‐lowering therapy adherence, and consider nonstatin therapy. We sought to determine whether clinician lipid testing practices were consistent with these guidelines.Methods and ResultsThe PALM (Patient and Provider Assessment of Lipid Management) registry enrolled primary and secondary prevention patients from 140 US cardiology, endocrinology, and primary care offices in 2015 and captured demographic data, lipid treatment history, and the highest LDL‐C level in the past 2 years. Core laboratory lipid levels were drawn at enrollment. Among 7627 patients, 2787 (36.5%) had no LDL‐C levels measured in the 2 years before enrollment. Patients without chart‐documented LDL‐C levels were more often women, nonwhite, uninsured, and non–college graduates (all P<0.01). Patients without prior lipid testing were less likely to receive statin treatment (72.6% versus 76.0%; P=0.0034), a high‐intensity statin (21.5% versus 24.3%; P=0.016), nonstatin lipid‐lowering therapy (24.8% versus 27.3%; P=0.037), and had higher core laboratory LDL‐C levels at enrollment (median 97 versus 92 mg/dL; P<0.0001) than patients with prior LDL‐C testing. Of 166 individuals with core laboratory LDL‐C levels ≥190 mg/dL, 36.1% had no LDL‐C measurement in the prior 2 years, and 57.2% were not on a statin at the time of enrollment.ConclusionsIn routine clinical practice, LDL‐C testing is associated with higher‐intensity lipid‐lowering treatment and lower achieved LDL‐C levels.

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Provider understanding of the 2013 ACC/AHA cholesterol guideline

Cited by 62 publications

References 29 publications

Effect of 2013 ACC/AHA Blood Cholesterol Guidelines on Statin Treatment Patterns and Low‐Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Patients

Effect of 2013 ACC/AHA Blood Cholesterol Guidelines on Statin Treatment Patterns and Low‐Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Patients

Case-based educational intervention to assess change in providers' knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry

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