Boekeloo B O, Becker D M, LeBailly A, Pearson T A
Johns Hopkins Medical Institutions, Preventive Cardiology Programs, Baltimore, Maryland.
Am J Prev Med. 1988 May-Jun;4(3):128-32.
There is now substantial scientific evidence that patients with coronary heart disease (CHD) have a high prevalence of hypercholesterolemia and stand to benefit significantly from efforts to lower cholesterol levels. To evaluate physician practice patterns and attitudes concerning cholesterol assessment and management of patients hospitalized with an admitting diagnosis of CHD, one-month medical record audits were performed during 1983, 1984, and 1985, and a physician survey was administered in early 1986. Medical records of 154 inpatients hospitalized with a diagnosis of CHD before 60 years of age showed that, on the average, 18% had lipid profiles ordered and 11% received a low-fat diet in the hospital. The admission history and follow-up notes mentioned the presence or absence of lipid abnormalities in 53% of CHD inpatients. No significant changes occurred from 1983 to 1985. Survey results from 184 hospital staff physicians caring for these patients showed that less than half believed that a reduction in blood cholesterol lowers risk for heart disease in middle-aged patients with CHD. Interns and residents indicated less confidence in the efficacy of cholesterol-lowering diet and drug therapy than did attending physicians. The implications of these findings for physician training are discussed in light of recent studies of the efficacy of cholesterol lowering in secondary prevention.
目前有大量科学证据表明，冠心病（CHD）患者中高胆固醇血症的患病率很高，降低胆固醇水平的努力有望使其显著受益。为了评估医生对确诊为CHD的住院患者进行胆固醇评估和管理的实践模式及态度，于1983年、1984年和1985年进行了为期一个月的病历审核，并于1986年初开展了一项医生调查。对154名60岁以前确诊为CHD的住院患者的病历分析显示，平均而言，18%的患者进行了血脂检查，11%的患者在住院期间接受了低脂饮食。入院病史和随访记录提及了53%的CHD住院患者存在或不存在血脂异常情况。从1983年到1985年没有显著变化。对184名负责这些患者的医院医生的调查结果显示，不到一半的医生认为降低血液胆固醇可降低中年CHD患者患心脏病的风险。实习生和住院医生对降低胆固醇饮食和药物治疗效果的信心低于主治医生。根据近期关于二级预防中降低胆固醇疗效的研究，讨论了这些发现对医生培训的意义。
