A community-wide survey of physician practices and attitudes toward cholesterol management in patients with recent acute myocardial infarction
Department of Medicine, Division of Cardiovascular Medicine
Anticholesteremic Agents; Cholesterol; Cholesterol, LDL; Data Collection; Female; Humans; Hypercholesterolemia; Male; Massachusetts; Middle Aged; Myocardial Infarction; *Physician's Practice Patterns; Questionnaires
Life Sciences | Medicine and Health Sciences
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.
DOI of Published Version
Arch Intern Med. 2002 Apr 8;162(7):797-804.
Archives of internal medicine
Yarzebski, Jorge L.; Bujor, Carmen F.; Goldberg, Robert J.; Spencer, Frederick A.; Lessard, Darleen M.; and Gore, Joel M., "A community-wide survey of physician practices and attitudes toward cholesterol management in patients with recent acute myocardial infarction" (2002). Open Access Articles. 230.