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Review
.2019 Apr 1;123(7):1011-1018.
doi: 10.1016/j.amjcard.2018.12.031. Epub 2019 Jan 4.

Association of Clinician Knowledge and Statin Beliefs With Statin Therapy Use and Lipid Levels (A Survey of US Practice in the PALM Registry)

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Review

Association of Clinician Knowledge and Statin Beliefs With Statin Therapy Use and Lipid Levels (A Survey of US Practice in the PALM Registry)

Angela Lowenstern et al. Am J Cardiol..

Abstract

Guideline implementation requires clinician knowledge but may be influenced by pre-existing beliefs and biases. We assessed the association of these clinician factors with lipid management following the release of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines. In the PALM registry, 774 clinicians completed a survey to assess their knowledge of the 2013 American College of Cardiology/American Heart Association guidelines, belief in statin benefit, and statin safety concerns. The association of these factors with statin use, statin dosing, and low-density lipoprotein cholesterol (LDL-C) levels were assessed in the 6,839 patients treated by these clinicians between May and November 2015. Overall, 63.9% of clinicians responded to at least 3 out of 4 hypothetical scenarios in concordance with guideline recommendations (good tested knowledge), 88.4% reported belief in statin benefit, and 15.4% raised concerns about statin safety. Belief in statin benefit was more prevalent among cardiologists, who represented 48.8% of the clinicians surveyed, and concerns regarding statin safety were higher among noncardiologists and clinicians in an academic setting. Guideline knowledge was not associated with a difference in statin use (74.1% vs 73.8%, p = 0.84) and achievement of LDL-C level <100 mg/dl (54.7% vs 52.4%, p = 0.07). However, patients treated by clinicians who reported belief in statin benefit were more likely to receive guideline-recommended statin intensity (41.9% vs 36.9%, p = 0.03), whereas patients treated by clinicians expressing statin safety concerns were less likely receive statins of at least guideline-recommended intensity (36.8% vs 42.5%, p = 0.001) and to achieve an LDL-C <100 mg/dl (44.1% vs 56.1%, p <0.001); the latter persisted after multivariable adjustment (odds ratio 0.75, 95% confidence interval 0.63 to 0.89). In conclusion, clinician beliefs regarding benefits and risks of statins were significantly associated with guideline adherence and patients' achieved LDL-C levels, whereas clinician knowledge of guideline recommendations was not.

Copyright © 2019 Elsevier Inc. All rights reserved.

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Figures

Figure 1.
Figure 1.. Statin Use and Guideline-Concordant Statin Dosing among Patients with a Guideline Indication for Statin Therapy
Belief in Benefit – Reported statins effective in reducing atherosclerotic cardiovascular disease (ASCVD) risk and prolonging life. Dose – Percent of patients with statin dosing at or above guideline-recommended statin intensity. Guideline Knowledge – Answered ≥3 of 4 knowledge questions related to guideline recommendations correctly. Safety Concerns – Reported worry about statin therapy risks and that statin therapy risks are under-reported. Use – Percent of patients in which statin is used.
Figure 2.
Figure 2.. Achievement of LDL-C<100 mg/dL among Patients with a Guideline Indication for Statin Therapy
LDL-C, low-density lipoprotein cholesterol
See this image and copyright information in PMC

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