University of Nottingham, Nottingham, UK.
Barts Health NHS Trust, London, UK.
Adv Ther. 2023 Jan;40(1):233-251. doi: 10.1007/s12325-022-02344-6. Epub 2022 Oct 26.
The 2019 European Society of Cardiology and European Atherosclerosis Society (2019 ESC/EAS) guidelines stress the importance of managing low-density lipoprotein cholesterol (LDL-C) after myocardial infarction (MI) to reduce the risk of cardiovascular events. Information on guideline implementation is limited. The aim of this survey was to describe current clinical practice regarding LDL-C management in the first year post-MI across Europe, improving understanding of the role of ESC/EAS guidelines on clinical practice.
A qualitative web-based cross-sectional physician survey about the patient pathway and LDL-C management post-MI was conducted in 360 physicians from France, Italy, Germany, The Netherlands, Spain, and the UK (n = 60/country) between December 2019 and June 2020. Secondary and primary care physicians (SCPs/PCPs) described their experiences treating patients post-MI over the preceding 2 months.
Physicians reported that on average 90.7% of patients not prescribed lipid-lowering therapy (LLT) before an MI initiated LLT as inpatients; for patients already taking LLT, treatment was intensified for 64.7% of inpatients post-MI. SCPs reported prescribing higher-intensity statins and/or ezetimibe for between 72.3% (Italy) and 88.6% (UK) of patients post-MI. More than 80.0% of SCPs and 51.2% of PCPs stated that they would initiate a change in LLT immediately if patients did not achieve their LDL-C treatment goal by 12 weeks post-MI; 82.0% of SCPs and 55.1% of PCPs reported referring to 2019 ESC/EAS guidelines for management of patients post-MI. Barriers to initiating PCSK9 inhibitors (PCSK9is) included prior prescription of a maximally tolerated dose of statin (49.4%) and/or ezetimibe (38.9%), requirement to reach threshold LDL-C levels (44.9%), and pre-authorization requirements (30.4%).
Differences in clinical practice post-MI were reported across the countries surveyed, including divergence between 2019 ESC/EAS and local guidelines. Increased use of innovative medicines to achieve LDL-C goals should reduce risk of subsequent cardiovascular events in very high-risk patients post-MI.
2019 年欧洲心脏病学会（ESC）和欧洲动脉粥样硬化学会（EAS）指南强调了在心肌梗死后（MI）管理低密度脂蛋白胆固醇（LDL-C）以降低心血管事件风险的重要性。有关指南实施的信息有限。本调查的目的是描述欧洲 MI 后第一年 LDL-C 管理的当前临床实践，以更好地了解 ESC/EAS 指南对临床实践的作用。
2019 年 12 月至 2020 年 6 月，在法国、意大利、德国、荷兰、西班牙和英国的 360 名医生中进行了一项关于 MI 后患者通路和 LDL-C 管理的定性在线横断面医生调查（n=60/国家）。二级和初级保健医生（SCP/PCP）描述了他们在过去 2 个月内治疗 MI 后患者的经验。
医生报告说，平均有 90.7%的 MI 前未开降脂治疗（LLT）的患者在入院时开始使用 LLT；对于已经服用 LLT 的患者，64.7%的住院患者在 MI 后进行了治疗强化。SCP 报告称，在 MI 后，72.3%（意大利）至 88.6%（英国）的患者开具了更高强度的他汀类药物和/或依折麦布。超过 80.0%的 SCP 和 51.2%的 PCP 表示，如果患者在 MI 后 12 周内未达到 LDL-C 治疗目标，他们将立即开始改变 LLT；82.0%的 SCP 和 55.1%的 PCP 报告称，他们将参考 2019 ESC/EAS 指南管理 MI 后患者。启动前蛋白转化酶枯草溶菌素 9 抑制剂（PCSK9is）的障碍包括先前开具最大耐受剂量的他汀类药物（49.4%）和/或依折麦布（38.9%）、需要达到阈值 LDL-C 水平（44.9%）和预先授权要求（30.4%）。
调查国家报告的 MI 后临床实践存在差异，包括 2019 ESC/EAS 指南和当地指南之间的差异。为了达到 LDL-C 目标，增加使用创新药物应降低 MI 后极高危患者发生后续心血管事件的风险。
