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A Community-Wide Survey of Physician Practices and Attitudes Toward Cholesterol Management in Patients With Recent Acute Myocardial Infarction
Jorge Yarzebski, MD, MPH;
Carmen F. Bujor, MD;
Robert J. Goldberg, PhD;
Frederick Spencer, MD;
Darleen Lessard, MS;
Joel M. Gore, MD
Arch Intern Med. 2002;162:797-804.
Background Physicians' current attitudes and practices toward the management of
high cholesterol levels in patients with recent acute myocardial infarction
are not well defined.
Objective To examine threshold levels of serum cholesterol and other factors that
influence physicians' decision to prescribe lipid-lowering drugs and initiate
dietary therapy in patients with recent acute myocardial infarction.
Methods Community-wide questionnaire survey of general internists, cardiologists,
and family physicians practicing in the Worcester, Mass, metropolitan area.
Results Among the 257 responding physicians, lipid-lowering drug therapy was
more likely to be initiated in younger patients at lower total serum and low-density
lipoprotein (LDL) cholesterol levels than in older patients (P = .03). Younger physicians were more likely to initiate dietary and
lipid-lowering drug therapy at lower total and LDL cholesterol levels than
their older counterparts. Younger physicians also considered LDL cholesterol
level the most important factor in initiating lipid-lowering drug therapy
in contrast to older physicians who favored total cholesterol level (P = .001). General practice physicians were more likely
to initiate dietary therapy at lower total cholesterol levels, but tended
to initiate lipid-lowering drug therapy at higher total and LDL cholesterol
levels compared with internists and cardiologists. Physicians reported that
the most important factors that interfere with patients' use of lipid-lowering
medication were concerns about medication costs, issues related to polypharmacy,
and failure to recognize the importance of lipid-lowering drugs. Several physician-associated
factors, including perceived importance of other cardiac drugs and provider
responsibility, were associated with the nonuse of lipid-lowering medications.
Conclusion Educational and practice-based efforts remain necessary to remove potential
barriers to the implementation of effective long-term cholesterol management
in patients with recent acute myocardial infarction.
From the Department of Medicine, Division of Cardiovascular Medicine,
University of Massachusetts Medical School, Worcester.
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