Have the Government's prescription algorithm and the 2013 American College of Cardiology/American Heart Association guidelines for managing dyslipidaemia influenced the management of dyslipidaemia? The MEJORALO-CV Project
Por:
Giner Galvañ V, Bonig Trigueros I, Fácila Rubio L, Morillas Blasco P, Martínez Hervás S, Pascual Fuster V, Valls Roca F, Soler Portmann C, Tamarit García JJ and Pallarés Carratalá V
Publicada:
1 jun 2020
Ahead of Print:
17 nov 2019
Categoría:
Medicine (miscellaneous)
Resumen:
Objective: To determine the management of dyslipidaemia in primary care after the publication of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines and Valencian government's algorithm.
Method: We conducted a cross-sectional descriptive study that employed a survey of primary care physicians of the Community of Valencia between January and October 2016.
Results: A total of 199 physicians (mean age, 48.9 +/- 11.0 years; experience, 21.3 +/- 11.1 years) participated in the survey. The most followed guidelines were those of the European Society of Cardiology (37.5% of respondents) and Valencian government (23.4% of respondents). Some 6.3% of the respondents followed the 2013 ACC/AHA guidelines, and 88.0% established objectives based on LDL cholesterol and cardiovascular risk. The choice of lipid-lowering drug was based on its LDL cholesterol lowering capacity (28.6% of respondents), on the Valencian government's algorithm (23.4%) and on the drug's safety (20.4%). Statins, ezetimibe and fibrates were the preferred hypolipemiant agents, and their combination (51% of respondents) and dosage increases (35%) were the strategies employed for poor control. Lipid profile and transaminase and creatine kinase levels were measured every 6 (59.5%, 52.3% and 54.3% of respondents, respectively) or 12 months (25.1%, 29.2% and 30.3%, respectively). Forty-one percent of the respondents were aware of the controversy surrounding the 2013 ACC/AHA guidelines. Although 60% of the respondents acknowledged its relevance, only 21% changed their daily practices accordingly.
Conclusions: The Valencian government's algorithm had a greater impact than the 2013 ACC/AHA guidelines in primary care in Valencia. Areas for improvement included the low use of validated guidelines and risk tables and the streamlining of laboratory test periodicity. (C) 2019 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.
Filiaciones:
:
Unidad de HTA y Riesgo Cardiometabólico, Servicio de Medicina Interna, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, España
Departamento de Medicina Clínica, Facultad de Medicina, Universidad Miguel Hernández, Elche, Alicante, España
:
Servicio de Medicina Interna, Hospital de La Plana, Villarreal (Castellón), España
Fácila Rubio L:
Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, España
:
Servicio de Cardiología, Hospital General Universitario de Elche, Elche (Alicante), España
Martínez Hervás S:
Servicio de Endocrinología, Hospital Clínico Universitario de Valencia, Valencia, España
:
Centro de Salud Palleter, Castellón, España
:
Centro de Salud de Benigànim, Benigànim (Valencia), España
Soler Portmann C:
Unidad de HTA y Riesgo Cardiometabólico, Servicio de Medicina Interna, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, España
Departamento de Medicina Clínica, Facultad de Medicina, Universidad Miguel Hernández, Elche, Alicante, España
Tamarit García JJ:
Servicio de Medicina Interna, Hospital General Universitario, Valencia, España
Pallarés Carratalá V:
Unión de Mutuas, Castellón, España
Departamento de Medicina, Universitat Jaume I, Castellón, España
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