Physicians' perception of guideline-recommended low-density lipoprotein target values: characteristics of misclassified patients.
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.
Sager
Hendrik B
HB
Medizinische Klinik II, Universitätsklinik Schleswig Holstein, Campus Lübeck, Ratzeburger Allee, Lübeck, Germany.
Linsel-Nitschke
Patrick
P
Mayer
Björn
B
Lieb
Wolfgang
W
Franzel
Brigitte
B
Elsasser
Ulrich
U
Schunkert
Heribert
H
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*
D008077:Lipoproteins, LDL