- In 2013, new guidelines were published for managing cholesterol to reduce the risk of developing atherosclerotic heart disease (ASCVD).
- In the new study, researchers analyzed data from the National Outpatient Health Survey from 2006 to 2016. This investigated her 11,033 outpatients from adults with ASCVD.
- Fewer than half of ASCVD patients were prescribed statins In 2016, I received aspirin and lifestyle counseling.
- Health care providers were less likely to prescribe ASCVD preventive treatments for women and non-Hispanic blacks.
In 2013,
ASCVD is a general term for heart and blood vessel disorders, including coronary artery disease, ischemic stroke, transient ischemic attack, and peripheral artery disease.is more than
Revised guidelines in 2013 expanded the eligible group for statin therapy to all adults with known ASCVD, regardless of individual low-density lipoprotein cholesterol levels.
Some experts say the 2013 guidelines represent a fundamental change in how doctors treat high cholesterol.
Under the new guidelines, one study estimates that the number of adults eligible for statins, drugs that can lower blood cholesterol, will increase by 12.8 million.
However, in a recently published study,
Because treatment with low-dose aspirin was recommended for secondary prevention in ASCVD patients, the researchers also looked at the proportion of patients prescribed aspirin. Did.
Dr. Ambar Kulshreshtha, associate professor at Emory University School of Medicine and co-author of the study, said: medical news today.
For this cross-sectional study, researchers:
Researchers analyzed the years 2006 to 2016 in their study. Their data included those diagnosed with myocardial infarction, angina pectoris, ischemic stroke, transient ischemic attack, peripheral artery disease, or those diagnosed with ASCVD, who underwent coronary revascularization. It looked at patients over the age of 21. This procedure unblocks or widens the blood vessels that supply the heart and restores blood flow.
The data were divided into two groups, pre- and post-2013 recommendations. Researchers looked to see if health care workers prescribed statins or aspirin or offered lifestyle counseling to their patients.
Researchers conducted a statistical analysis of the data in March 2021.
Between 2006 and 2016, researchers identified 11,033 visits involving adults with ASCVD. This equates to a total of 275.3 million visits.
The median age of these patients was 70 years. Female patients made up her 40.7% of the visitors. 9.2% of the visitors were Hispanic, 9.9% were non-Hispanic black, and 90.1% were non-Hispanic white.
Of the patients, 69.5% had hypertension, 57.5% had hyperlipidemia, and 29% had diabetes. Researchers considered about 11% of patients to be obese.
In 2006, 41.3% of patients received an aspirin prescription. That number jumped to 47.5% for him in 2016. Meanwhile, in 2006, approximately 33% of patients received lifestyle coaching. That number he dropped to 22.3% in 2016.
Approximately 43.3% of the female patients surveyed were prescribed statins. On the other hand, 52.7% of her men were given statins. Approximately 40% of female patients were prescribed aspirin, compared with her 48.5% of male patients. Health professionals provided her lifestyle counseling to 22.9% of women compared to 23% of men.
Among non-Hispanic black patients, 41.6% received statins, 41.1% were prescribed aspirin, and 24.2% received lifestyle counseling. Among Caucasian patients, 49.8% received statins, 45.9% were prescribed aspirin, and 23.3% received lifestyle counseling.
Approximately 47% of patients seen at a primary care physician’s office were prescribed statins, and approximately 33% were prescribed aspirin. Of the patients who visited a medical clinic, 51.7% were prescribed statins and 43.1% were prescribed aspirin. Of the patients presenting to cardiology, 55.6% were prescribed statins and 56.2% were prescribed aspirin.
Dr. Krushleshta said some doctors were hesitant to change their recommendations when new guidelines for treating patients were released. MNT“So whenever guidelines come out, especially when they are controversial, following these guidelines is, you know, very clinical inertia,” he said. Told.
Dr. Krushleshta said MNT There are currently “several quality improvement initiatives underway” aimed at engaging providers in ensuring that second-line treatment guidelines for ASCVD are being followed. “But our data suggests that more needs to be done,” he said. MNT.
MNT also talked to Anthony Mufare, a 2021 graduate of the Master of Public Health program at Emory University and a co-author of the study, a current student at the Central Michigan University School of Medicine. Mufarreh said there are several reasons primary care providers don’t offer her ASCVD patients more frequent lifestyle coaching.
According to Mufarreh, medical students are under-educated in nutrition and exercise. “We have very little … training and very little implementation of it in a clinical sense,” he said.
According to Dr. Kulshreshtha, the length of time the office allows for patient visits in the United States also makes it difficult for health care providers to discuss sensitive topics such as exercise and dietary changes. We’re only given a 15-minute window, and often less,” he said.
According to Dr. Kulshreshtha, one option to solve this problem is to have someone on your health care team do lifestyle coaching. “Do I have to rely on the doctor for all that?” he asked. “Or maybe we work like a team-based practice, so can one of his doctor’s assistants take over that part?”
Dr. Kulshreshtha said that motivational interviewing, a counseling approach that takes into account a patient’s personal needs and conflicting feelings about the need for change, is an effective technique for motivating patients to change their exercise and eating habits. I have discovered that there is a possibility.
By talking to patients about their personal motivations and barriers to making change, they can gain investment, he explained. MNT.
“They want to take ownership and change something,” said Dr. Krushleshta. “[But] It’s not like ending a conversation with a piece of paper that says, “I need to exercise 150 minutes a week and eat a lot.” Yes, you can hear it, but it comes out the other ear. I think what we really need is a time to talk and understand where our patients come from. ”
Before publishing the data, Mufarreh expected a disparity in the treatment of female and black ASCVD patients. However, he was surprised by the magnitude of the disparity revealed by his study.
“One of the big things is, honestly, we are aware that these disparities exist,” Mufarreh said. MNT.
He said public health officials could initiate targeted interventions if data showed that women and black patients were not being treated equally.
Dr. Kulshreshtha believes another way to solve this problem is to train health care providers on implicit bias.
“I think providers need to be universally trained on that,” he said. MNT. “In my opinion, it should be taught in all medical schools and emphasized over and over again in the course of training.”
Researchers found that less than half of known ASCVD patients in 2016 were prescribed statins, aspirin or received lifestyle counseling, and that there are disparities in the management of ASCVD, so next steps is to study how these problems can be improved.Krushleshta said MNT.
“I think that’s how we progress, don’t you think?” he said. “We identify gaps and find ways to solve them.”
