A community-wide survey of physician practices and attitudes toward cholesterol management in patients with recent acute myocardial infarction.

Abstract

Physicians' current attitudes and practices toward the management of high cholesterol levels in patients with recent acute myocardial infarction are not well defined. To examine threshold levels of serum cholesterol and other factors that influence physicians' decision to prescribe lipid-lowering drugs and initiate dietary therapy in patients with recent acute myocardial infarction. Community-wide questionnaire survey of general internists, cardiologists, and family physicians practicing in the Worcester, Mass, metropolitan area. Among the 257 responding physicians, lipid-lowering drug therapy was more likely to be initiated in younger patients at lower total serum and low-density lipoprotein (LDL) cholesterol levels than in older patients (P =.03). Younger physicians were more likely to initiate dietary and lipid-lowering drug therapy at lower total and LDL cholesterol levels than their older counterparts. Younger physicians also considered LDL cholesterol level the most important factor in initiating lipid-lowering drug therapy in contrast to older physicians who favored total cholesterol level (P =.001). General practice physicians were more likely to initiate dietary therapy at lower total cholesterol levels, but tended to initiate lipid-lowering drug therapy at higher total and LDL cholesterol levels compared with internists and cardiologists. Physicians reported that the most important factors that interfere with patients' use of lipid-lowering medication were concerns about medication costs, issues related to polypharmacy, and failure to recognize the importance of lipid-lowering drugs. Several physician-associated factors, including perceived importance of other cardiac drugs and provider responsibility, were associated with the nonuse of lipid-lowering medications. Educational and practice-based efforts remain necessary to remove potential barriers to the implementation of effective long-term cholesterol management in patients with recent acute myocardial infarction.