title: Therapeutic inertia in the outpatient management of dyslipidemia in patients with ischemic heart disease. The inertia study.
abstract: OBJECTIVE
  Studies indicate that dyslipidemia is undertreated. Numerous systematic reviews have shown that, even when therapeutic targets set by clinical practice guidelines have not been met, treatment remains unchanged despite the availability of alternatives approaches. The result is increased morbidity and mortality. Our aims were to investigate this phenomenon, known as therapeutic inertia, in patients with dyslipidemia and ischemic heart disease, and to determine its possible causes.
  
  
  METHODS
  
  
  
  METHODS
  national, multicenter, observational study of data obtained from physicians by questionnaire and from the clinical records of patients with ischemic heart disease. Main variable: therapeutic inertia during a consultation, defined as treatment remaining the same despite a change being indicated (e.g. low-density lipoprotein cholesterol >100 mg/dl or >70 mg/dl in diabetics). Covariates: physician, patient and consultation characteristics.
  
  
  METHODS
  multivariate logistic regression analysis of factors associated with therapeutic inertia during a consultation.
  
  
  RESULTS
  Overall, 43% of consultations involved therapeutic inertia, and an association with coronary risk factors, including diabetes, did not result in a change in treatment. Therapeutic inertia occurred more frequently when there was a long time between the diagnosis and treatment of dyslipidemia and that of ischemic heart disease. Undertreatment was particularly common in women despite a greater overall risk. The more experienced physicians treated younger patients more appropriately. Clinical practice was improved by educational sessions at conferences.
  
  
  CONCLUSIONS
  Therapeutic inertia was common in patients with chronic ischemic heart disease and dyslipidemia, irrespective of overall cardiovascular risk. Factors associated with the patient, disease and physician had an influence.
authors.affiliation: Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, España.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lázaro
authors.forename: Nekane
authors.initials: N
authors.lastname: Murga
authors.forename: Dolores
authors.initials: D
authors.lastname: Aguilar
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Hernández-Presa
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D008078:Cholesterol, LDL / Q000097:blood; D050171:Dyslipidemias / Q000150:complications / Q000628:therapy*; D005260:Female; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000628:therapy*; D012017:Referral and Consultation; D012307:Risk Factors; D013030:Spain; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL