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
This article has been cited by other articles:
 |
|
 |
|
  H. M. Krumholz, J. L. Anderson, B. L. Bachelder, F. M. Fesmire, S. D. Fihn, J. M. Foody, P. M. Ho, M. N. Kosiborod, F. A. Masoudi, and B. K. Nallamothu ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction) Developed in Collaboration With the American Academy of Family Physicians and American College of Emergency Physicians Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, and Society of Hospital Medicine J. Am. Coll. Cardiol., December 9, 2008; 52(24): 2046 - 2099. [Full Text] [PDF]
|
|
|
|
 |
|
 WRITING COMMITTEE MEMBERS, H. M. Krumholz, J. L. Anderson, B. L. Bachelder, F. M. Fesmire, S. D. Fihn, J. M. Foody, P. M. Ho, M. N. Kosiborod, F. A. Masoudi, et al. ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction): Developed in Collaboration With the American Academy of Family Physicians and the American College of Emergency Physicians: Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, and Society of Hospital Medicine Circulation, December 9, 2008; 118(24): 2596 - 2648. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ovbiagele, J. L. Saver, H. Bang, L. E. Chambless, A. Nassief, J. Minuk, J. F. Toole, J. R. Crouse, and for the VISP Study Investigators Statin treatment and adherence to national cholesterol guidelines after ischemic stroke Neurology, April 25, 2006; 66(8): 1164 - 1170. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Mosca, N. B. Merz, R. S. Blumenthal, M. J. Cziraky, R. P. Fabunmi, C. Sarawate, K. E. Watson, V. J. Willey, and E. J. Stanek Opportunity for Intervention to Achieve American Heart Association Guidelines for Optimal Lipid Levels in High-Risk Women in a Managed Care Setting Circulation, February 1, 2005; 111(4): 488 - 493. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. D. Woodard, N. R. Kressin, and L. A. Petersen Is Lipid-Lowering Therapy Underused by African Americans at High Risk of Coronary Heart Disease Within the VA Health Care System? Am J Public Health, December 1, 2004; 94(12): 2112 - 2117. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Lappe, J. B. Muhlestein, D. L. Lappe, R. S. Badger, T. L. Bair, R. Brockman, T. K. French, L. C. Hofmann, B. D. Horne, S. Kralick-Goldberg, et al. Improvements in 1-Year Cardiovascular Clinical Outcomes Associated with a Hospital-Based Discharge Medication Program Ann Intern Med, September 21, 2004; 141(6): 446 - 453. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Brophy, C. Bourgault, and P. Brassard The use of cholesterol-lowering medications after coronary revascularization Can. Med. Assoc. J., November 25, 2003; 169(11): 1153 - 1157. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. D. Aronow, G. M. Novaro, M. S. Lauer, D. M. Brennan, A. M. Lincoff, E. J. Topol, D. J. Kereiakes, and S. E. Nissen In-Hospital Initiation of Lipid-Lowering Therapy After Coronary Intervention as a Predictor of Long-term Utilization: A Propensity Analysis Arch Intern Med, November 24, 2003; 163(21): 2576 - 2582. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W. Bergstrom The Need to Improve Diabetes Care, May 1, 2003; 26(5): 1633 - 1634. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Shepherd Combined lipid lowering drug therapy for the effective treatment of hypercholesterolaemia Eur. Heart J., April 2, 2003; 24(8): 685 - 689. [Full Text] [PDF]
|
|
|
|
 |
|
 W. Lalouschek, W. Lang, S. Greisenegger, and M. Mullner Determination of Lipid Profiles and Use of Statins in Patients With Ischemic Stroke or Transient Ischemic Attack Stroke, January 1, 2003; 34(1): 105 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. S. Ockene, L. L. Hayman, R. C. Pasternak, E. Schron, and J. Dunbar-Jacob Task Force #4--adherence issues and behavior changes: achieving a long-term solution J. Am. Coll. Cardiol., August 21, 2002; 40(4): 630 - 640. [Full Text] [PDF]
|
|
|
|
|
|
C. N. B. Merz, G. A. Mensah, V. Fuster, P. Greenland, and P. D. Thompson Task Force #5--the role of cardiovascular specialists as leaders in prevention: from training to champion J. Am. Coll. Cardiol., August 21, 2002; 40(4): 641 - 649. [Full Text] [PDF]
|
|
|
|
|
|
R. T. Tsuyuki, J. A. Johnson, K. K. Teo, S. H. Simpson, M. L. Ackman, R. S. Biggs, A. Cave, W.-C. Chang, V. Dzavik, K. B. Farris, et al. A Randomized Trial of the Effect of Community Pharmacist Intervention on Cholesterol Risk Management: The Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP) Arch Intern Med, May 27, 2002; 162(10): 1149 - 1155. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Lacy, D.-C. Suh, J. A. Barone, M. Bueno, D. Moylan, C. Swartz, R. V. Kudipudi, and J. B. Kostis Impact of a Targeted Intervention on Lipid-Lowering Therapy in Patients With Coronary Artery Disease in the Hospital Setting Arch Intern Med, February 25, 2002; 162(4): 468 - 473. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. J. Greenlund, W. H. Giles, N. L. Keenan, J. B. Croft, G. A. Mensah, and S. L. Huston Physician Advice, Patient Actions, and Health-Related Quality of Life in Secondary Prevention of Stroke Through Diet and Exercise * The Physician's Role in Helping Patients to Increase Physical Activity and Improve Eating Habits Stroke, February 1, 2002; 33(2): 565 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Erdman, C. B. Cook, K. J. Greenlund, W. H. Giles, I. El-Kebbi, G. J. Ryan, D. L. Gallina, D. C. Ziemer, V. G. Dunbar, and L. S. Phillips The Impact of Outpatient Diabetes Management on Serum Lipids in Urban African-Americans With Type 2 Diabetes Diabetes Care, January 1, 2002; 25(1): 9 - 15. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. P. Brass Changing the Status of Drugs from Prescription to Over-the-Counter Availability N. Engl. J. Med., September 13, 2001; 345(11): 810 - 816. [Full Text] [PDF]
|
|
|
|
|
|
A. I. Qureshi, M. F. K. Suri, L. R. Guterman, and L. N. Hopkins Ineffective Secondary Prevention in Survivors of Cardiovascular Events in the US Population: Report From the Third National Health and Nutrition Examination Survey Arch Intern Med, July 9, 2001; 161(13): 1621 - 1628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Yarzebski, F. Spencer, R. J. Goldberg, D. Lessard, and J. M. Gore Temporal Trends (1986-1997) in Cholesterol Level Assessment and Management Practices in Patients With Acute Myocardial Infarction: A Population-Based Perspective Arch Intern Med, June 25, 2001; 161(12): 1521 - 1528. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.M. Krumholz Gaps and opportunities in the practice of medicine: the need for improved systems of care Eur. Heart J., June 1, 2001; 22(11): 889 - 890. [PDF]
|
|
|
|
|
|
S. John, C. Delles, J. Jacobi, M. P. Schlaich, M. Schneider, G. Schmitz, and R. E. Schmieder Rapid improvement of nitric oxide bioavailability after lipid-lowering therapy with cerivastatin within two weeks J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1351 - 1358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. C. Fonarow, W. J. French, L. S. Parsons, H. Sun, and J. A. Malmgren Use of Lipid-Lowering Medications at Discharge in Patients With Acute Myocardial Infarction : Data From the National Registry of Myocardial Infarction 3 Circulation, January 2, 2001; 103(1): 38 - 44. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Cooper, J. Cutler, P. Desvigne-Nickens, S. P. Fortmann, L. Friedman, R. Havlik, G. Hogelin, J. Marler, P. McGovern, G. Morosco, et al. Trends and Disparities in Coronary Heart Disease, Stroke, and Other Cardiovascular Diseases in the United States : Findings of the National Conference on Cardiovascular Disease Prevention Circulation, December 19, 2000; 102(25): 3137 - 3147. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Grant, J. P. Frolkis, P. Suhan, J. Schwartz, and S. J. Zyzanski Documentation for the Sake of Documentation? • Response Circulation, September 28, 1999; 100(13): 1461 - 1461. [Full Text] [PDF]
|
|
|
|
|
|
J. Dupuis, J.-C. Tardif, P. Cernacek, and P. Theroux Cholesterol Reduction Rapidly Improves Endothelial Function After Acute Coronary Syndromes : The RECIFE (Reduction of Cholesterol in Ischemia and Function of the Endothelium) Trial Circulation, June 29, 1999; 99(25): 3227 - 3233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Danias, D. I. Silverman, J. P. Frolkis, P. Suhan, J. Schwartz, and S. J. Zyzanski Physician Noncompliance With the 1993 National Cholesterol Education Program (NCEP-ATPII) Guidelines • Response Circulation, June 29, 1999; 99 (25): 3323 - 3326. [Full Text] [PDF]
|
|
|
|
 |
|
 Compliance with Cholesterol Guidelines Remains Poor Journal Watch Cardiology, October 9, 1998; 1998(1009): 2 - 2. [Full Text]
|
|