title: Physicians' perception of guideline-recommended low-density lipoprotein target values: characteristics of misclassified patients.
abstract: OBJECTIVE
  The present study investigated the awareness of primary care physicians for patient characteristics relevant for designation of low-density lipoprotein (LDL) target values.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medizinische Klinik II, Universitätsklinik Schleswig Holstein, Campus Lübeck, Ratzeburger Allee, Lübeck, Germany.
authors.forename: Hendrik B
authors.initials: HB
authors.lastname: Sager
authors.forename: Patrick
authors.initials: P
authors.lastname: Linsel-Nitschke
authors.forename: Björn
authors.initials: B
authors.lastname: Mayer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lieb
authors.forename: Brigitte
authors.initials: B
authors.lastname: Franzel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Elsasser
authors.forename: Heribert
authors.initials: H
authors.lastname: Schunkert
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence / Q000592:standards; D003951:Diagnostic Errors; D005260:Female; D005858:Germany; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000517:prevention & control*; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010465:Perception; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*
chemical_list: D008077:Lipoproteins, LDL