November 8, 2015 – A large majority of doctors reported using the new ACC/AHA guidelines to guide statin therapy.
Although most healthcare providers say they adhere to current guidelines regarding lipid management strategies, many of them do not follow all of the guidelines.
That is the finding of a study presented in a poster session presented Sunday at the annual Scientific Sessions of the American Heart Association in Orlando, Florida.
In 2013, the AHA and the American College of Cardiology issued new cholesterol guidelines that focused on treatment based on a patient’s risk of cardiovascular disease. Among other things, these guidelines expanded statin recommendations in the United States, resulting in about 13 million new people being recommended for treatment, including most adults over 60. The degree to which these guidelines have been adopted by healthcare providers, however, has been unclear.
In this study, the DCRI researchers used data from the Patient and provider Assessment of Lipid Management (PALM) registry, which contains data on lipid-lowering therapy use among adult patients receiving primary and subspecialty care in the United States. The registry has a targeted enrollment of 7,500 patients.
“As part of the PALM registry, we’re surveying both patients and providers about their experiences with cholesterol-lowering medications to get an idea of what’s really happening in community practice,” said the DCRI’s Ann Marie Navar, MD, the study’s lead author.
At each participating sites, providers were asked to complete a survey about their lipid management practices. The survey included questions about statin prescribing patterns and guideline adherence. The final dataset included completed surveys from 761 providers at 182 sites.
The majority of respondents (73.7 percent) reported using the new guidelines primarily to guide statin therapy. Only 16.8 percent of providers reported nearly “always” (75-100 percent of patients) discussing lipid management with patients when discussing statins for primary prevention, compared with 31.6 percent of providers who reported discussing such options “often” (50-75 percent of patients).
Compared with their practice one year ago, providers reported more often prescribing high-intensity statins and calculating a patient’s 10-year risk of developing atherosclerotic cardiovascular disease (ASCVD), as recommended by the current guidelines.
These results, the researchers concluded, illustrate the need to better understand how guidelines affect real-world practice.
“There’s a huge opportunity here to improve delivery of statin therapy to patients through understanding how providers are actually treating their patients,” Navar said. “This could translate into significant reductions in cardiovascular disease in the community.”
In addition to Navar, the study’s Duke authors included Eric Peterson, MD, MPH; Laura Webb; Michael Pencina, PhD; and Tracy Wang, MD, MHS, MSc.