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FACTORS INFLUENCING ACHIEVEMENT OF LOW-DENSITY LIPOPROTEIN CHOLESTEROL GOALS IN MEXICO: THE INTERNATIONAL CHOLESTEROL MANAGEMENT PRACTICE STUDY.
Bello-Chavolla, OY, Aguilar-Salinas, CA
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion. 2019;(6):408-416
Abstract
BACKGROUND The International Cholesterol Management Practice Study is a multinational collaborative effort to describe the effectiveness of the lipid-lowering therapy (LLT) as well as the main barriers to achieve the low-density lipoprotein cholesterol (LDL-C) goals. OBJECTIVE The objective of the study was to investigate factors associated with the achievement of LDL-C goals in Mexico using real-life data. METHODS This was a cross-sectional observational study from 18 physicians across different health facilities in Mexico, who provided information about their practices between August 2015 and August 2016. We included patients treated for ≥3 months with any LLT in whom LDL-C measurement on stable LLT was available for the previous 12 months. RESULTS We included 623 patients with a mean age of 59.3 ± 12.7 years; 55.6% were women. The mean LDL-C value on LLT was 141.8 ± 56.1 mg/dL. At enrollment, 97.4% of patients were receiving statin therapy (11.3% on high-intensity treatment). Only 24.8% of the very-high cardiovascular (CV) risk patients versus 26.4% of the high risk and 52.4% of the moderate risk patients achieved their LDL-C goals. Independent factors associated with non-achievement of LDL-C goal were statin intolerance, overweight and obesity, abdominal obesity, female sex, high CV risk, use of public health-care service, metabolic syndrome, type 2 diabetes, and hypertriglyceridemia. Higher-level of education was associated with a lower risk of not achieving LDL-C goals. CONCLUSIONS Achievement of LDL-C goals is suboptimal in Mexico, especially in patients with the highest CV risk. The main barriers to achieve the goal are easily detectable. Implementation of LLT should be adapted to the patient's needs and profile.
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Effect of physician characteristics and knowledge on the quality of dyslipidemia management and LDL-C target goal achievement in China: Subgroup analysis of the Dyslipidemia International Study.
Ding, R, Ye, P, Zhao, S, Zhao, D, Yan, X, Dong, Y, Li, J, Ran, Y, Hu, D, ,
Journal of global health. 2017;(2):020702
Abstract
OBJECTIVE This study aimed to investigate the effect of physicians' characteristics and knowledge of LDL-C target goals on the quality of lipid management in China. METHODS A total of 25 317 dyslipidemia patients who had taken lipid-lowering medication for >3 months were enrolled in our study. Patients' demographic data, medical history, lipid profile, their physician's specialty and professional title and their hospital level as well as their LDL-C goal opinions were recorded. RESULTS Questionnaires were completed by 926 physicians with 6 different specialties and 4 professional statuses, in 3 different-level hospitals. Most (74.5%) of the physicians recognized the importance of considering LDL-C serum concentration for treating dyslipidemia, and set target LDL-C goals according to the 2007 Chinese guidelines for 83.4% of their patients. The LDL-C goal achievement rate was significantly higher for patients whose physicians' knowledge of LDL-C target goals was consistent with guideline recommendations, compared with those whose physicians' knowledge was inconsistent with the guidelines (60.4% vs 31.1%, P < 0.0001). Physicians working in tier 1 (odds ration (OR) = 2.95; 95% CI 2.37-3.67), (OR = 1.56; 95% CI 1.34-1.81) and tier 2 (OR = 2.53; 95% CI 2.22-2.88), (OR = 1.16; 95% CI 1.06-1.27) hospitals, specialized in neurology (OR = 1.13; 95% CI 0.93-1.36), (OR = 1.57; 95% CI 1.40-1.77), internal medicine (OR = 1.07; 95% CI 0.90-1.27), (OR = 1.58; 95% CI 1.39-1.80), endocrinology (OR = 1.02; 95% CI 0.87-1.21), (OR = 1.63; 95% CI 1.47-1.82) and being a resident vs attending physician (OR = 1.05; 95% CI 0.92-1.20), (OR = 1.00; 95% CI 1.00-1.19) were independent risk factors for low knowledge of LDL-C target goals and low LDL-C goal achievement. CONCLUSION Chinese physicians' characteristics and knowledge of LDL-C target goals were associated with patients' LDL-C goal achievement.
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Turkish doctors' cohort: healthy despite low screening.
Unal, S, Tanriover, MD, Ascioglu, S, Demirkazik, A, Ertenli, I, Eskioglu, E, Guler, K, Kiraz, S, Ozbakkaloglu, M, Ozer, B, et al
Postgraduate medicine. 2017;(3):393-398
Abstract
OBJECTIVES We aimed to determine the prevalence of chronic diseases and unhealthy lifestyle behaviors of Turkish doctors as compared with the general population and the frequency of compliance with preventive clinical practices among doctors. METHODS This was an observational, prospective cohort study that enrolled graduates between 1975 and 2004 from six medical schools in Turkey. Data on demographics, disease conditions, and unhealthy lifestyle behaviors were gathered. Preventive care practices were analyzed with regards to age and gender. RESULTS A total of 7228 doctors participated in the study. Comparison with the national data revealed higher hyperlipidemia and coronary artery disease rates. While 54.5% of the doctors had a doctor visit in the last 12 months, only 31.5% of those over 40 years of age reported a recent blood pressure measurement. Colon cancer screening rate over 50 years of age with any of the acceptable methods was only 3%. One-fourth of the female doctors over 40 years of age underwent mammography within the last two years. Only 7.1% of the doctors over 65 years of age and 10% of the doctors having an indication for a chronic disease had a pneumococcal vaccine, while nearly one-fifth had no hepatitis B vaccine. CONCLUSION In this cohort of mainly middle-aged Turkish doctors, the age-standardized rates of chronic diseases were lower than the rates in the general population except for the rates of hyperlipidemia and coronary artery disease. However, doctors did show quite low rates of receipt of screening practices. These results might provoke questions about how to use Turkish doctors' health behaviors to further improve doctors' and, relatedly, patients' health.
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Physicians' guideline adherence is associated with better prognosis in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry.
Komajda, M, Cowie, MR, Tavazzi, L, Ponikowski, P, Anker, SD, Filippatos, GS, ,
European journal of heart failure. 2017;(11):1414-1423
Abstract
AIMS: To evaluate the impact of physicians' adherence to guideline-recommended medications for heart failure with reduced ejection fraction (HFrEF), including ≥50% prescription of recommended doses, on clinical outcomes at 6-month follow-up. METHODS AND RESULTS In QUALIFY, an international, prospective, observational, longitudinal survey, 6669 outpatients with HFrEF were recruited 1-15 months after heart failure (HF) hospitalization from September 2013 to December 2014 in 36 countries and followed up at 6 months. A global adherence to guidelines score was developed for prescription of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs) and ivabradine and their dosages. Baseline global adherence score was good in 23% of patients, moderate in 55%, and poor in 22%. At 6-month follow-up, poor adherence was associated with significantly higher overall mortality [hazard ratio (HR) 2.21, 95% confidence interval (CI) 1.42-3.44, P=0.001], cardiovascular mortality (HR 2.27, 95% CI 1.36-3.77, P=0.003), HF mortality (HR 2.26, 95% CI 1.21-4.2, P=0.032), combined HF hospitalization or HF death (HR 1.26, 95% CI 1.08-1.71, P=0.024) and cardiovascular hospitalization or cardiovascular death (HR 1.35, 95% CI 1.08-1.69, P=0.013). There was a strong trend between poor adherence and HF hospitalization (HR 1.32, 95% CI 1.04-1.68, P=0.069). CONCLUSION Good adherence to pharmacologic treatment guidelines for ACEIs, ARBs, BBs, MRAs and ivabradine, with prescription of at least 50% of recommended dosages, was associated with better clinical outcomes during 6-month follow-up. Continuing global educational initiatives are needed to emphasise the importance of guideline recommendations for optimising drug therapy and prescribing evidence-based doses in clinical practice.
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[Physician knowledge and attitudes on the clinical evaluation and treatment of resistant hypertension: The RESIST study].
Coca, A
Hipertension y riesgo vascular. 2017;(1):4-16
Abstract
BACKGROUND Resistant hypertension (RH) is associated with a high risk of cardiovascular and renal complications. The purpose of this study was to assess the knowledge and attitudes of Primary Care physicians, general medicine doctors, and clinical cardiologists on the management of this condition. MATERIAL AND METHODS A multicentre, descriptive, observational study based on an ad hoc questionnaire distributed to Primary Care physicians (n=1017) and general medicine physicians/clinical cardiologists (n=457). RESULTS To establish the diagnosis of resistant hypertension, 69.1% of physicians confirm that systolic/diastolic blood pressure is above 140/90 mmHg, despite treatment. Furthermore, 64.9% only consider this diagnosis if the patient is treated with at least 3 medications, and 50.3% also requires that one of them is a thiazide diuretic (56.7% among specialists, P=.0004). To establish a definite diagnosis of true RH, 89.6% perform 24-h ambulatory blood pressure monitoring (93.3% of specialists, P=.0017), looking specifically for «white-coat» effect in 70.2% of cases. In addition, 79.3% verify that adherence to treatment is adequate. Between 87 and 95% of physicians indicate examinations to exclude causes of secondary hypertension. Up to 54.3% of physicians (71.3% specialists, P<.0001) consider adding a fourth drug and insisting on lifestyle interventions as a priority therapeutic measure. CONCLUSION These data show that physician knowledge regarding the management of patients with RH is good. Interestingly, this knowledge is somewhat higher among specialists than among Primary Care physicians.
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Impact of atherosclerosis detection by carotid ultrasound on physician behavior and risk-factor management in asymptomatic hypertensive subjects.
Hong, SJ, Chang, HJ, Song, K, Hong, GR, Park, SW, Kang, HJ, Kim, EJ, Kim, DS, Jeong, MH
Clinical cardiology. 2014;(2):91-6
Abstract
BACKGROUND There are limited data regarding the impact of atherosclerosis detection by carotid ultrasound (CUS) on physician prevention efforts and risk-factor management for cardiovascular disease. HYPOTHESIS Atherosclerosis detection by CUS in asymptomatic hypertensive patients would lead to physician prevention efforts, including target low-density lipoprotein cholesterol (LDL-C) level and prescription. Also, it may improve risk-factor management. METHODS A total of 347 asymptomatic hypertensive subjects (age 61 ± 8 years, 189 men) were prospectively recruited from 22 hospitals. Prior to CUS, physicians were surveyed regarding target LDL-C level. After CUS, patients were classified into positive CUS (n = 182) and negative CUS (n = 165) groups based on CUS results. Physicians were resurveyed to assess whether the initial target LDL-C goals were changed. At 6 months, cardiovascular risk-factor modification status was reassessed. RESULTS The proportion of lowered target LDL-C levels was significantly larger in the positive CUS group than in the negative CUS group (52% vs 23%, P < 0.001). These results were observed even in subjects who had low and moderate risk according to National Cholesterol Education Program-Adult Treatment Panel III guidelines. Lipid-lowering agents were similarly added or switched to another class in both groups (7% in the positive CUS group vs 11% in the negative CUS group, P = 0.153). LDL-C was significantly decreased in the positive CUS group (Δ = -24 ± 38 mg/dL, P < 0.001), whereas it was not significantly decreased in the negative CUS group (Δ = -6 ± 31 mg/dL, P = 0.105). CONCLUSIONS Atherosclerosis detection by CUS lowered physicians' target LDL-C level and improved cardiovascular risk management in terms of LDL-C reduction.