Medizinische Klinik II, Universitätsklinik Schleswig Holstein, Campus Lübeck, Ratzeburger Allee, Lübeck, Germany.
Eur Heart J. 2010 May;31(10):1266-73. doi: 10.1093/eurheartj/ehq026. Epub 2010 Mar 10.
The present study investigated the awareness of primary care physicians for patient characteristics relevant for designation of low-density lipoprotein (LDL) target values.
Physicians (n = 907) were asked to estimate guideline-recommended LDL target value for 30 of their patients with hyperlipidaemia. In total, 25 250 patients were allocated on that basis in three different groups (LDL target <100, <130, and <160 mg/dL), in which by guideline criteria 68.0, 21.9, and 10.1% of patients, respectively, were allocated. We analysed (by logistic regression) whether physicians utilized risk factors and co-morbidities appropriately for assignment of correct LDL target values. Overall, physicians estimated recommended LDL target values correctly in 55.1% of male vs. 49.1% of female patients (P < 0.001). In the group with LDL targets of <100 mg/dL, correct assignment was most often given to male patients with a history of myocardial infarction (MI; 77.1%). In comparison with this group, increasing probabilities for incorrect assignment were found in patients with documented coronary artery disease (CAD) without a history of MI [odds ratio (OR): 2.08, 95% confidence intervals (95% CI): 1.87-2.33], CAD-equivalent conditions (OR: 2.30, 95% CI: 2.08-2.55), and a 10-year risk >20% based on calculated risk scores (OR: 2.69, 95% CI: 2.40-3.02). Next, physicians were grouped, based on the number of correct assignments they gave to their patients, in quartiles of guideline knowledge. In patients from physicians of the top performing quartile (>90% of correct assignments), LDL levels were significantly lower than in the second, third, and fourth quartiles (LDL 134.3, 138.8, 145.5, 151.4 mg/dL, P < 0.001 between all groups).
In primary care, about half of high-risk patients receive correct assignment of guideline-recommended LDL targets by their physicians. Perception of correct LDL target values varied largely depending on patients' gender and co-morbid conditions. Poor perception of risk resulted in lower rates of objective LDL target achievement.
本研究旨在调查初级保健医生对与低密度脂蛋白（LDL）目标值指定相关的患者特征的认知情况。
研究共纳入 907 名医生，要求他们为 30 名高脂血症患者估算指南推荐的 LDL 目标值。在此基础上，将 25250 名患者分为三组，LDL 目标值分别为<100mg/dL、<130mg/dL 和<160mg/dL。根据指南标准，分别有 68.0%、21.9%和 10.1%的患者被分配到这三组。我们通过逻辑回归分析了医生是否恰当地利用了危险因素和合并症来确定正确的 LDL 目标值。总体而言，医生在 55.1%的男性患者和 49.1%的女性患者中正确估算了推荐的 LDL 目标值（P<0.001）。在 LDL 目标值<100mg/dL 的组中，有心肌梗死（MI）病史的男性患者的正确赋值率最高（77.1%）。与该组相比，在有记录的冠状动脉疾病（CAD）但无 MI 病史的患者中[比值比（OR）：2.08，95%置信区间（95%CI）：1.87-2.33]、CAD 等效情况（OR：2.30，95%CI：2.08-2.55）和基于计算风险评分的 10 年风险>20%的患者中[OR：2.69，95%CI：2.40-3.02]，不正确赋值的可能性增加。接下来，根据他们为患者提供的正确赋值数量，医生被分为指南知识的四分位组。在来自排名前四分之一（>90%的赋值正确）的医生的患者中，LDL 水平显著低于第二、三、四分位组（LDL 分别为 134.3、138.8、145.5、151.4mg/dL，所有组之间 P<0.001）。
在初级保健中，大约一半的高危患者得到了医生对指南推荐的 LDL 目标值的正确赋值。对正确 LDL 目标值的感知差异很大，取决于患者的性别和合并症情况。对风险的认知不足导致 LDL 目标的客观达标率较低。
