Abstract 14646: Internal Medicine Housestaff Perceptions of Statins and ACC/AHA Blood Cholesterol Guidelines
Background: Statins are integral in the prevention of atherosclerotic cardiovascular disease (ASCVD). Provider perceptions and prescribing practices of statins vary. Internal medicine housestaff (HS) perceptions of statins and new ACC/AHA cholesterol guidelines have not previously been assessed.
Methods: We examined internal medicine HS perceptions of statins and ACC/AHA cholesterol guidelines through a 48-question survey. We surveyed HS at three academic training programs. Anonymous responses were collected via a secure website.
Results: 99 respondents’ results (84% categorical residents) were examined from Emory, Johns Hopkins, and UTSW. HS report observing low rates of statin side effects: 64% and 91% reported rates of <3% and <10%. Majority of side effects were myalgias (69%), transaminitis (23%), and gastrointestinal symptoms (5%). Over half (54%) of respondents check transaminases prior to statin therapy. If transaminitis >1-2x upper limit of normal (ULN) develop only 6% of residents stop statin therapy, though 62% stop therapy if transaminitis >3x ULN. In stable liver disease, 13% use non-statin therapy. Most residents (73%) agree that patients understand why they are prescribed statins and feel compliance is influenced by experienced/perceived risk of side effects (44%), cost (30%), and medical benefit (13%). However, HS do not discuss side effects in 25% of patients and only 44% agree patients frequently ask about side effects. Additionally, only 51% of HS discuss ASCVD risk with a majority of patients. HS perceive high rates of statin adherence (87% state >50% adherence at one year).
Of 61 HS, 72% learned of new lipid guidelines through residency training. Nearly all (89%) read a portion of the guidelines and are likely to implement them (97%). However, only 57% agree the guidelines are clear or straightforward to apply in clinical practice and 66% agreed the guidelines will improve/reduce ASCVD risk. Only 48% agree new guidelines will improve quality of patient care.
Conclusion: Practice patterns of statin therapy vary among medicine HS. Side effects and ASCVD risk are not frequently discussed with patients. Though HS are aware of new cholesterol guidelines, a gap exists between implementation and perceived benefits/ASCVD risk reduction.
Author Disclosures: P. Flueckiger: None. S. Juraschek: None. M. Eades: None. A. Khera: None. M. Blaha: None. L. Sperling: None.
- © 2014 by American Heart Association, Inc.