Physicians’ misperceived cardiovascular risk and therapeutic inertia as determinants of low LDL-cholesterol targets achievement in diabetes

Mario Luca Morieri, Olga Lamacchia, Enzo Manzato, Andrea Giaccari, Angelo Avogardo, Lucio Amoresano, Stefania Angotti, Laura Bartone, Francesco Caraffa, Antonello Carboni, Stefano Carro, Silvestre Cervone, Alessandra Clerico, Ida Console, Danilo Mario Conti, Sergio D’Addato, Alessandra De Bellis, Andrea De Bellis, Francesco De Meo, Alberto Di CarloGraziano Di Cianni, Giuseppe Di Giovanni, Sergio Di Lembo, Fabrizio Diacono, Mara Dolcino, Giovanni Elia, Paolo Elli, Cristina Fatone, Angelica Galli, Giovanni Galluzzo, Adriana Garzaniti, Renata Ghelardi, Anna Giacchini, Loretta Giunta, Francesco Golia, Franco Gregorio, Dario Ierna, Antonio Lampitella, Antonio Luciano, Ada Maffettone, Raffaele Mancini, Ida Mangone, Linneo Enzo Mantovani, Alberto Marangoni, Giuseppe Marelli, Narciso Marin, Gennaro Marino, Eugenio Mastromatteo, Gaetano Mazziotti, Elisa Me, Giuseppe Memoli, Laura Silvia Maria Menicatti, Simona Moffa, Manuela Moise’, Fabrizio Monaco, Sara Nazzarena Morgante, Francesca Pellicano, Ettore Petraroli, Deamaria Piersanti, Antonino Pipitone, Susanna Puglisi, Maura Rinaldi, Mario Rizzo, Maura Rosco, Principia Maria Rosco, Giampaolo Scollo, Natalino Simioni, Mariarosaria Squadrone, Giacomo Sturniolo, Anna Tedeschi, Alessandra Tedeschi, Biagio Tizio, Diletta Ugolotti, Livio Valente, Carmela Vinci, Luca Zenoni, Maria Grazia Zenti

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Background: Greater efforts are needed to overcome the worldwide reported low achievement of LDL-c targets. This survey aimed to dissect whether and how the physician-based evaluation of patients with diabetes is associated with the achievement of LDL-c targets. Methods: This cross-sectional self-reported survey interviewed physicians working in 67 outpatient services in Italy, collecting records on 2844 patients with diabetes. Each physician reported a median of 47 records (IQR 42–49) and, for each of them, the physician specified its perceived cardiovascular risk, LDL-c targets, and the suggested refinement in lipid-lowering-treatment (LLT). These physician-based evaluations were then compared to recommendations from EAS/EASD guidelines. Results: Collected records were mostly from patients with type 2 diabetes (94%), at very-high (72%) or high-cardiovascular risk (27%). Physician-based assessments of cardiovascular risk and of LDL-c targets, as compared to guidelines recommendation, were misclassified in 34.7% of the records. The misperceived assessment was significantly higher among females and those on primary prevention and was associated with 67% lower odds of achieving guidelines-recommended LDL-c targets (OR 0.33, p < 0.0001). Peripheral artery disease, target organ damage and LLT-initiated by primary-care-physicians were all factors associated with therapeutic-inertia (i.e., lower than expected probability of receiving high-intensity LLT). Physician-suggested LLT refinement was inadequate in 24% of overall records and increased to 38% among subjects on primary prevention and with misclassified cardiovascular risk. Conclusions: This survey highlights the need to improve the physicians’ misperceived cardiovascular risk and therapeutic inertia in patients with diabetes to successfully implement guidelines recommendations into everyday clinical practice.
Lingua originaleEnglish
pagine (da-a)57-N/A
RivistaCardiovascular Diabetology
Volume21
DOI
Stato di pubblicazionePubblicato - 2022

Keywords

  • Adherence
  • Cardiovascular risk
  • Ezetimibe
  • Inertia
  • Misperceived risk
  • PCSK9i
  • Primary care physicians
  • Real-world
  • Real-world study
  • Self-reported survey
  • Statins

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