The attitudes of physicians toward guideline recommendations for the management of dyslipidemia in clinical practice - The VIPFARMA ISCP Project

Abstract

Guideline recommendations for the management of dyslipidemia, based on current trial evidence and/or expert consensus, aim at improving atherosclerotic cardiovascular disease progression and clinical outcomes. The degree to which physicians accept and implement these recommendations, however, varies markedly depending on a number of factors. To explore the different attitudes of physicians regarding international recommendations for the management of dyslipidaemia in routine medical practice, the International Society of Cardiovascular Pharmacotherapy carried out a survey among physicians taking part in the Surveillance of Prescription Drugs in the Real World Project (VIPFARMA - ISCP Project). Methods. Seven clusters of questions were designed to characterize demographics, institutional profile, medical education, clinical practice profile, knowledge and attitudes regarding the use of statins, PCSK9 inhibitors, and triglyceride lowering agents. Results. The survey was completed by 898 Argentine physicians, of whom 68.3% were cardiologists and 40.0% had specialties related to cardiovascular prevention. Contrary to the recommendations of the Guidelines, 29.6% of physicians supported LDL goals above 70 mg/dl in secondary prevention. Acceptance of values lower than 70 mg/dl was associated with greater levels of continuing education (OR 0.64, 95% CI 0.45-0.91; p=0.014), specialization in preventive cardiology (OR 0.49, 95% CI 0.28-0.88; p=0.017) or diabetology (OR 0.48, 95% CI 0.24-0.98; p=0.043). A less aggressive attitude toward the achievement of guideline goals, such as rejection of the use of statins in diabetics (OR 2.83, 95% CI 1.30-6.18; p=0.009), reduction in statin dose (OR 2.87, 95% CI 2.02-4.10; p=<0.001) or discontinuation when LDL values less than 35 mg/dl are reached (OR 4.32, 95% CI 1.81-10.29; p=0.001) were observed in physicians who considered LDL values higher than 70 mg/dl as the goal in secondary prevention. Conclusions. One third of physicians in the survey do not follow goals recommended by international guidelines for secondary prevention. Lower levels of continuing medical education and incomplete knowledge of the recommended treatment goals appear to be important reasons for not implementing guideline recommendations in clinical practice