Risk assessment of atherosclerotic cardiovascular diseases before statin therapy initiation: Knowledge, attitude, and practice of physicians in Yemen

Abstract

Background Risk evaluation of atherosclerotic cardiovascular disease (ASCVD) remains the cornerstone of primary prevention. The cardiovascular risk assessment can guide the decision-making on various preventive measures such as initiating or deferring statin therapy. Thus, our study aimed to assess the physicians’ knowledge, attitude, and practices regarding atherosclerotic cardiovascular diseases risk assessment. Also, we evaluated the physician-patient discussion and counseling practices before statin therapy initiation in concordance with recommendations from the latest clinical practice guideline. Methods A cross-sectional study was conducted between November 2020 and January 2021. A self-administered questionnaire was distributed to 350 physicians (GPs, residents, specialists, and consultants). Two trained pharmacists distributed the questionnaires in 5 major tertiary governmental hospitals and more than ten private hospitals. Also, private clinics were targeted so that we get a representative sample of physicians at different workplaces. Results A total of 270 physicians filled the questionnaire out of 350 physicians approached, with 14 being excluded due to high missing data, giving a final response rate of 73%. Participants had suboptimal knowledge and practices with a high positive attitude toward atherosclerotic cardiovascular diseases risk assessment. The knowledge and practices were higher among consultants, participants from the cardiology department, those with experience years of more than nine years, and those who reported following a specific guideline for cholesterol management or using a risk calculator in their practice. Notably, the risk assessment and counseling practices were lower among physicians who reported seeing more patients per day. Conclusion Physicians had overall low knowledge, suboptimal practices, and a high positive attitude toward cardiovascular risk assessment. Therefore, physicians’ training and continuing medical education regarding cholesterol management and primary prevention clinical practice guidelines are recommended. Also, the importance of adherence to clinical practice guidelines and their impact on clinical outcomes should be emphasized.

Atherosclerotic cardiovascular disease risk among Ghanaians: A comparison of the risk assessment tools.

“…Despite the availability of ASCVD risk calculators, barriers to their implementation include time constraints, accessibility limitations, poor clinician uptake, patient fears, lack of documented workflows, staffing issues, concerns about out-of-pocket costs, and inadequate communication within the team [40] . In Yemen, a low-income country in West Asia, there was a highly positive attitude toward ASCVD risk assessment however, overall knowledge was low, and practices were suboptimal [41] . Persons with longer years in practice, specialization in cardiology, and compliance with specific guidelines were most associated with higher knowledge and better practices.…”

Physicians and pharmacists’ clinical knowledge of statin therapy and monitoring parameters, and the barriers to guideline implementation in clinical practice

“…This knowledge gap among healthcare providers could result in the underutilization of statins among patients with clinical indications. Indeed, we recently have reported knowledge and practice gaps regarding CVD risk assessment among physicians and pharmacists [12,13].…”

“…However, healthcare providers' lack of knowledge about up-to-date guideline recommendations is one of the most common barriers to guideline implementation in clinical practice [9]. Previous studies have reported knowledge gaps among physicians and/or pharmacists regarding cholesterol management guidelines and/or CVD risk assessment before statin therapy initiation [10][11][12][13]. For example, two studies from the USA that were done among healthcare providers [14] and clinical pharmacists [15] reported several knowledge gaps about guidelines, particularly those related to ASCVD risk assessment and statin therapy clinical indications.…”

Transformer-based Neural Network for Electrocardiogram Classification

“…Cardiovascular diseases (CVDs) happen due to malfunctions in the heart as well as blood vessels. CVDs are one of the main causes of global deaths as issued by the World Health Organization (WHO) [1], CVDs share 32% of the global death causes in 2019. ECG is an essential tool for CVDs diagnoses and treatment, also it is required for continuous heart monitoring.…”