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Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey
BACKGROUND: Goal attainment of guideline-recommended low-density lipoprotein cholesterol (LDL-C) is suboptimal. Little is known about how patient factors influence physicians’ treatment decision-making in hypercholesterolemia. We examined physicians’ treatment recommendations in high-risk patients w...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457981/ https://www.ncbi.nlm.nih.gov/pubmed/25985907 http://dx.doi.org/10.1186/s12944-015-0037-y |
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author | Krempf, Michel Simpson, Ross J Ramey, Dena Rosen Brudi, Philippe Giezek, Hilde Tomassini, Joanne E Lee, Raymond Farnier, Michel |
author_facet | Krempf, Michel Simpson, Ross J Ramey, Dena Rosen Brudi, Philippe Giezek, Hilde Tomassini, Joanne E Lee, Raymond Farnier, Michel |
author_sort | Krempf, Michel |
collection | PubMed |
description | BACKGROUND: Goal attainment of guideline-recommended low-density lipoprotein cholesterol (LDL-C) is suboptimal. Little is known about how patient factors influence physicians’ treatment decision-making in hypercholesterolemia. We examined physicians’ treatment recommendations in high-risk patients whose LDL-C remained uncontrolled despite statin monotherapy. METHODS: Physicians completed a questionnaire prior to randomization into period I of a two-period randomized controlled trial evaluating LDL-C goal attainment in patients whose LDL-C remained ≥100 mg/dL after 5 weeks’ treatment with atorvastatin 10 mg/day (NCT01154036). Physicians’ treatment recommendations were surveyed for two hypothetical and one real scenario: (1) LDL-C presumed near goal (between 100–105 mg/dL), (2) LDL-C presumed far from goal (~120 mg/dL), and (3) observed baseline LDL-C of enrolled patients. Prognostic factors considered during decision-making were identified by regression analysis. Observed lipid outcomes at the end of period I (following 6 weeks’ treatment with ezetimibe 10 mg plus atorvastatin 10 mg, atorvastatin 20 mg, or rosuvastatin 10 mg) were compared with estimated LDL-C outcomes for physicians’ treatment recommendations after 6 weeks (based on individual patients’ pre-randomization LDL-C and expected incremental change). RESULTS: Questionnaires were completed for 1,534 patients. No change in therapy, or double atorvastatin dose, were frequently recommended, even when LDL-C was far from goal (6.5% and 52.2% of patients, respectively). Double atorvastatin dose was commonly recommended in all scenarios (43–52% of patients). More intensive LDL-C-lowering regimens were recommended infrequently e.g. double atorvastatin dose and add ezetimibe only <12% in all scenarios. Overall, cardiovascular risk factors and desire to achieve a more aggressive LDL-C goal were prominent factors in decision-making for treatment. Comparison of observed and estimated LDL-C levels showed that physicians tended to overestimate the effectiveness of their recommendations. CONCLUSIONS: This study provides insight into physicians’ perspectives on clinical management of hypercholesterolemia and highlights a gap in knowledge translation from guidelines to clinical practice. The need for lower LDL-C and cardiovascular risk were key drivers in clinical decision-making, but physicians’ treatment choices were more conservative than guideline recommendations, potentially resulting in poorer LDL-C reduction. When compared with actual outcomes, projected LDL-C control was better if physicians used more comprehensive strategies rather than simply doubling the statin dose. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01154036 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12944-015-0037-y) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4457981 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-44579812015-06-07 Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey Krempf, Michel Simpson, Ross J Ramey, Dena Rosen Brudi, Philippe Giezek, Hilde Tomassini, Joanne E Lee, Raymond Farnier, Michel Lipids Health Dis Research BACKGROUND: Goal attainment of guideline-recommended low-density lipoprotein cholesterol (LDL-C) is suboptimal. Little is known about how patient factors influence physicians’ treatment decision-making in hypercholesterolemia. We examined physicians’ treatment recommendations in high-risk patients whose LDL-C remained uncontrolled despite statin monotherapy. METHODS: Physicians completed a questionnaire prior to randomization into period I of a two-period randomized controlled trial evaluating LDL-C goal attainment in patients whose LDL-C remained ≥100 mg/dL after 5 weeks’ treatment with atorvastatin 10 mg/day (NCT01154036). Physicians’ treatment recommendations were surveyed for two hypothetical and one real scenario: (1) LDL-C presumed near goal (between 100–105 mg/dL), (2) LDL-C presumed far from goal (~120 mg/dL), and (3) observed baseline LDL-C of enrolled patients. Prognostic factors considered during decision-making were identified by regression analysis. Observed lipid outcomes at the end of period I (following 6 weeks’ treatment with ezetimibe 10 mg plus atorvastatin 10 mg, atorvastatin 20 mg, or rosuvastatin 10 mg) were compared with estimated LDL-C outcomes for physicians’ treatment recommendations after 6 weeks (based on individual patients’ pre-randomization LDL-C and expected incremental change). RESULTS: Questionnaires were completed for 1,534 patients. No change in therapy, or double atorvastatin dose, were frequently recommended, even when LDL-C was far from goal (6.5% and 52.2% of patients, respectively). Double atorvastatin dose was commonly recommended in all scenarios (43–52% of patients). More intensive LDL-C-lowering regimens were recommended infrequently e.g. double atorvastatin dose and add ezetimibe only <12% in all scenarios. Overall, cardiovascular risk factors and desire to achieve a more aggressive LDL-C goal were prominent factors in decision-making for treatment. Comparison of observed and estimated LDL-C levels showed that physicians tended to overestimate the effectiveness of their recommendations. CONCLUSIONS: This study provides insight into physicians’ perspectives on clinical management of hypercholesterolemia and highlights a gap in knowledge translation from guidelines to clinical practice. The need for lower LDL-C and cardiovascular risk were key drivers in clinical decision-making, but physicians’ treatment choices were more conservative than guideline recommendations, potentially resulting in poorer LDL-C reduction. When compared with actual outcomes, projected LDL-C control was better if physicians used more comprehensive strategies rather than simply doubling the statin dose. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01154036 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12944-015-0037-y) contains supplementary material, which is available to authorized users. BioMed Central 2015-05-19 /pmc/articles/PMC4457981/ /pubmed/25985907 http://dx.doi.org/10.1186/s12944-015-0037-y Text en © Krempf et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Krempf, Michel Simpson, Ross J Ramey, Dena Rosen Brudi, Philippe Giezek, Hilde Tomassini, Joanne E Lee, Raymond Farnier, Michel Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey |
title | Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey |
title_full | Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey |
title_fullStr | Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey |
title_full_unstemmed | Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey |
title_short | Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey |
title_sort | patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457981/ https://www.ncbi.nlm.nih.gov/pubmed/25985907 http://dx.doi.org/10.1186/s12944-015-0037-y |
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