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

The burden of elevated LDL-C and the impact on ASCVD risk remain high, as does underuse of guideline recommended lipid-lowering treatment (LLT). The extent of clinician familiarity with LLT guidelines and barriers to implementation are unknown.

A cross-sectional study design was used, consisting of a 30-min online survey of cardiologists and primary care physicians (PCPs). US physicians were included if they self-reported practicing for ≥ 2 years and prescribed LLT to ≥ 50 patients monthly. Survey questions about LLT practice perceptions were informed by literature and expert opinion. Responses were analyzed using descriptive statistics.

The study sample included 200 cardiologists and 201 PCPs (mean age 50 years, mostly male (76%) and white (63%)). One-fourth (25%) of cardiologists and 42% of PCPs reported being somewhat, slightly or not at all familiar with the 2018 US AHA/ACC Guideline on the Management of Blood Cholesterol. More than half of cardiologists (51%) and PCPs (64%) found at least one section of the guidelines confusing: almost a third of cardiologists (27%) and PCPs (28%) found guidance on LDL-C treatment goals confusing and about one-fifth of physicians (24% of PCP and 16% of cardiologists) reported confusion with the section on managing treatment choices. Both reported patient and administrative challenges to implementing lipid guidelines, most notably, patient resistance to taking prescription medication (62%). Other common implementation challenges included difficulty enforcing behavioral changes, patient's lack of understanding of risk, and administrative burden.

More than half of all physicians found at least one section of the LLT guidelines confusing and noted patient behavior as a major challenge to their implementation. This survey provides insights into physician perceptions regarding implementation of LLT guideline recommendations. Additional research is required to further understand the barriers to implementation and the associated impact on clinical decision making and patient outcomes.