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Awareness Among Primary Care Physicians in Canada of Guideline Recommendations for Lowering LDL-Cholesterol in
Zahra Taboun1, Neil Naik2, Vivien Brown3
1Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Insights
Canadian primary care physicians show gaps in applying new lipid guidelines for high-risk patients. Improved knowledge translation is needed for better cardiovascular risk management post-acute coronary syndrome and for those with diabetes.
Area of Science:
- Cardiology
- Primary Care Medicine
- Public Health
Background:
- Cardiovascular (CV) risk management for high-risk individuals is frequently managed by primary care physicians (PCPs).
- The 2021 Canadian Cardiovascular Society (CCS) lipid guidelines provide recommendations for managing patients with acute coronary syndrome (ACS) and those with diabetes.
- PCPs play a crucial role in implementing these guidelines for secondary CV risk reduction.
Purpose of the Study:
- To assess Canadian PCPs' awareness and implementation of the 2021 CCS lipid guideline recommendations.
- To identify challenges PCPs face in managing CV risk for patients post-ACS and those with diabetes.
- To evaluate PCP knowledge regarding lipid-lowering treatment intensification thresholds and therapies.
Main Methods:
- A survey was designed by PCPs and lipid specialists, including guideline coauthors.
- A national database was used to recruit 250 PCPs who completed the survey between January and April 2022.
- The survey probed awareness, practice patterns, and perceived challenges in CV risk management.
Main Results:
- Nearly all PCPs (97.2%) agreed on timely post-ACS follow-up (within 4 weeks).
- Many PCPs reported inadequate discharge summaries (44.4%) and felt lipid management was a specialist's role (41.6%).
- Significant knowledge gaps were observed regarding low-density lipoprotein cholesterol (LDL-C) intensification thresholds and appropriate use of PCSK9 inhibitors.
Conclusions:
- One year post-guideline publication, PCPs exhibit knowledge gaps concerning lipid management for high-risk patients.
- Challenges include inadequate discharge information, polypharmacy, and statin intolerance.
- Effective knowledge-translation programs are essential to bridge these gaps and improve guideline adherence.
Background:
Cardiovascular (CV) risk management for high-risk patients is often provided by primary care physicians (PCPs). We surveyed Canadian PCPs regarding their awareness and implementation of the 2021 Canadian Cardiovascular Society (CCS) lipid guideline recommendations for patients following an acute coronary syndrome (ACS) and those with diabetes but without CV disease.
Methods:
A committee of PCPs and specialists with lipid expertise, including some 2021 CCS lipid guideline coauthors, designed a survey to probe PCP awareness and practice patterns regarding CV risk management. From a national database, a total of 250 PCPs completed the survey between January and April 2022.
Results:
Almost all PCPs (97.2%) concurred that a post-ACS patient should be seen by their PCP within 4 weeks of hospital discharge (81.2% said within 2 weeks). Almost half (44.4%) responded that discharge summaries provided inadequate information, and 41.6% felt that lipid management post-ACS was the responsibility primarily of specialists. A total of 58.4% articulated that they face challenges when seeing a post-ACS patient, related to inadequate discharge information, complexities of polypharmacy and duration of therapies, and managing statin intolerance. A total of 63.2% and 43.6% correctly identified low-density lipoprotein cholesterol (LDL-C) intensification thresholds of 1.8 mmol/L in post-ACS patients, and 2.0 mmol/L in diabetes patients, respectively, and 81.2% incorrectly thought that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were indicated for patients with diabetes but without CV disease.
Conclusions:
One year following publication of the 2021 CCS lipid guidelines, our survey reveals knowledge gaps among responding PCPs regarding intensification thresholds and treatment options for patients post-ACS, or those with diabetes. Innovative and effective knowledge-translation programs to address these gaps are desirable.
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