Optimizing low-density lipoprotein cholesterol (LDL-C) management - a US physician survey of barriers and burdens

Improving care of patients with hyperlipidemia requires an understanding of the barriers physicians perceive in prescribing low-density lipoprotein cholesterol (LDL-C)-lowering therapies. This study explores physicians' perceptions of time and resource burdens, identify perceived patient adherence barriers, and examine factors influencing physicians' decision-making in LDL-C management.

This is a non-interventional, cross-sectional, online survey of US-based primary care practitioners (PCP) and cardiologists who recommended or provided lipid-lowering therapy (LLT) to ≥50 adults per month, practiced for ≥2 years, and completed the survey in English. The survey comprised multiple-choice, constant sum, and numerical questions about physician decision-making, patient management, and perceptions of patient attitudes/behaviors regarding LDL-C management. Descriptive univariate analyses were conducted.

200 PCPs and 200 cardiologists completed the survey. Most physicians reported prescribing lipid-lowering therapy (LLT) and that patients declined injectable proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). They attributed this refusal to cost/insurance, fear/discomfort taking injections, and a preference for oral therapies. Physicians viewed patients with a history of ASCVD, with LLT experience, and those with greater understanding of ASCVD risk to have higher LLT adherence compared to those without. Most physicians spent a median of 10 min in shared decision-making conversations, regardless of therapies they prescribed. They reported needing longer to instruct patients during adherence counseling for PCSK9is than for oral therapies.

Our findings suggest patient, clinician, and system barriers may all hinder LDL-C management and adherence. A greater understanding of the association between perceived barriers and real-world behaviors will help optimize lipid management.