From the Lipid Research Center, PHS Mount Sinai Medical Center (J.P.F.,
P.S.S.), Cleveland, Ohio; and Case Western Reserve University School of
Medicine (J.M.S.), Department of Medicine (J.P.F.) and Department of Family
Medicine (S.J.Z.), Cleveland, Ohio.
Correspondence to Joseph P. Frolkis, MD, PhD, FACP, Sections of Preventive Cardiology and Preventive Medicine, The Cleveland Clinic Foundation, Desk A42, 9500 Euclid Ave, Cleveland, OH 44195.
Background—We sought to determine the frequency with which
physicians follow National Cholesterol Education Program
(NCEP-ATPII) guidelines in screening for cardiovascular
risk factors and treating hyperlipidemia.
Methods and Results—We conducted a retrospective chart review on
randomly sampled charts of 225 patients admitted to the
coronary care unit between January and June 1996. The main
outcome measures were rates of physician screening for coronary
heart disease risk factors; rates of counseling for cigarette
cessation, diet, and exercise; and extent of use of NCEP algorithms for
obtaining LDL cholesterol values and treating
hypercholesterolemia. Screening rates for
interns (who performed best) were: cigarette use (89%), known
coronary heart disease (74%), hypertension (68%),
hyperlipidemia (59%), family history (56%), diabetes
(37%), postmenopausal hormone therapy (11%), and premature menopause
(1%). Four percent of smokers were counseled to quit, 14% of patients
were referred to dietitians, and 1% were encouraged to exercise. A
full lipid panel was obtained in 50% of patients in whom it was
indicated on the basis of NCEP criteria. Patients were more likely to
receive lipid-lowering treatment if NCEP criteria indicated that they
should, but 36% of hospitalized patients and 46% of patients who
should have been treated on discharge were not.
Conclusions—Physicians are poorly compliant with NCEP guidelines
for risk factor assessment and counseling, even in patients at high
risk for coronary heart disease. Physicians follow NCEP-ATPII
algorithms for obtaining an LDL value, a key step in evaluating the
need for treatment, only 50% of the time. NCEP criteria seem to
influence the decision to initiate lipid-lowering therapy, but
significant numbers of eligible patients remain untreated.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Physician Noncompliance With the 1993 National Cholesterol Education Program (NCEP-ATPII) Guidelines
Key Words: lipoproteins • risk factors • practice guidelines • compliance
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