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GOULD EDU: Cluster-Randomized Trial of an Educational Intervention to Improve Lipid-Lowering Guideline Adherence
Christopher P Cannon1, Christie M Ballantyne2, Deepak L Bhatt3
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Background:
Adherence to lipid-lowering therapy (LLT) guidelines is suboptimal, leading to poor achievement of low-density lipoprotein cholesterol (LDL-C) goals and elevated risk for atherosclerotic cardiovascular disease (ASCVD) events.
Objectives:
The purpose of this study was to determine whether an educational intervention targeting physicians improves optimization of LLT over 1 year for patients with ASCVD.
Methods:
GOULD (Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management) EDU (Education) was a 1-year extension in a subset of sites in the GOULD prospective, observational registry of United States patients with ASCVD. In a cluster-randomized, stepped-wedge design, sites were randomized to 2 waves of an educational intervention that included 2 webinars and access to interactive data reports showing site-specific performance alongside full-study data over the course of the study. Chart reviews assessed LLTs and patient outcomes. Outcomes assessed over 1 year included change in prescribed LLT, frequency of measurement of LDL-C, LDL-C levels, LDL-C goal achievement, and responses on a structured physician questionnaire.
Results:
Thirty sites were randomized to Step 1 (n = 616) and 26 sites to Step 2 (n = 382). The mean (SD) age was 70.2 (9.6) years, 61.1% (610/998) were male, and 85.3% (851/998) were White. During the study, 83.6% (820/981) of patients had no change in LLT, and intensification occurred in only 7.0% (69/981); intensification did not differ by intervention step. The percentage of patients who met the goal of LDL-C <70 mg/dL was 39.0% (202/518) at baseline and 39.5% (252/638) at 1 year.
Conclusions:
An educational intervention with physicians had little impact on LLT optimization or LDL-C goal achievement in patients with ASCVD over a 1-year period. Novel approaches are needed to improve LDL-C goal achievement. (Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management [GOULD] a Registry of High Cardiovascular Risk Subjects in the United States; NCT02993120).
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