Current Practices and Attitudes Toward Cholesterol Management in Patients With Recent Acute Myocardial Infarction: A Survey of Community Physicians
Background: Recurrent coronary events and mortality are associated with elevated serum cholesterol levels in patients with acute myocardial infarction (AMI). It’s unclear what physicians’ current attitudes and practices are toward the management of high cholesterol levels in patients with recent AMI. We carried out a survey of practicing physicians to examine factors that influence physicians prescription of lipid-lowering and dietary therapy in patients with recent AMI and threshold levels of cholesterol for intervention. Methods: Mailed questionnaire survey of general internists, cardiologists, and family physicians practicing and/or having admitting privileges to all Worcester (MA) metropolitan hospitals. Results: Among the 257 responding physicians, lipid lowering therapy was more likely to be initiated in younger patients at lower total and LDL-cholesterol levels than in older patients. Younger physicians were more likely to initiate dietary and lipid lowering drug therapy at lower total and LDL-cholesterol levels. General practice physicians were more likely to initiate dietary therapy at lower total cholesterol levels, but more likely to initiate lipid lowering drug therapy at higher total and LDL-cholesterol levels, than internists and cardiologists. The most important factors reported by physicians which interfered with patient’s use of lipid lowering drug therapy were their concerns about medication costs, issues related to polypharmacy, and failure to recognize the importance of lipid lowering drugs. Several physician associated factors including provider responsibility and importance of other cardiac drugs were associated with the more widespread use of these medications. Conclusions: Results of this survey in a representative sample of community physicians suggest that older physicians are less likely to implement recommended treatment guidelines in patients with recent AMI and high cholesterol. Additional efforts are needed to modify potential barriers to the implementation of effective long-term cholesterol management in patients with recent AMI.