Physician Perceptions, Knowledge, and Implementation of Lipid-Lowering Guidelines in the USA

Area of Science:

• Cardiology
• Clinical Practice Guidelines
• Healthcare Disparities

Background:

• Elevated LDL-C remains a significant risk factor for atherosclerotic cardiovascular disease (ASCVD).
• Underuse of guideline-recommended lipid-lowering treatment (LLT) persists despite high ASCVD risk.
• Clinician familiarity with and barriers to implementing LLT guidelines are not well understood.

Purpose of the Study:

• To assess US cardiologists' and primary care physicians' (PCPs) familiarity with current LLT guidelines.
• To identify perceived barriers to implementing LLT guideline recommendations in clinical practice.
• To understand physician perceptions influencing lipid management strategies.

Main Methods:

• A cross-sectional online survey was administered to 401 US physicians (200 cardiologists, 201 PCPs).
• Physicians surveyed had at least 2 years of practice and prescribed LLT to ≥50 patients monthly.
• Survey questions focused on guideline familiarity, perceived clarity, and implementation challenges, analyzed via descriptive statistics.

Main Results:

• 25% of cardiologists and 42% of PCPs reported limited familiarity with the 2018 AHA/ACC Cholesterol Guidelines.
• Over half of physicians found guideline sections confusing, particularly regarding LDL-C goals and treatment choices.
• Patient resistance to medication (62%), behavioral changes, risk understanding, and administrative burden were key implementation barriers.

Conclusions:

• A significant proportion of physicians struggle with LLT guideline familiarity and clarity.
• Patient-related factors, especially medication adherence, represent major obstacles to guideline implementation.
• Further research is needed to address these barriers and improve clinical decision-making for better patient outcomes.