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Vol. 220. Issue 5.
Pages 282-289 (June - July 2020)
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Vol. 220. Issue 5.
Pages 282-289 (June - July 2020)
Original article
Have the Government's prescription algorithm and the 2013 American College of Cardiology/American Heart Association guidelines for managing dyslipidemia influenced the management of dyslipidemia? The MEJORALO-CV Project
¿Han influido el algoritmo de prescripción de la Administración y las guías de manejo de la dislipemia de la ACC/AHA 2013 en el manejo de la dislipemia? Proyecto MEJORALO-CV
V. Giner Galvaña,b,
Corresponding author
giner_vicgal@gva.es

Corresponding author.
, I. Bonig Triguerosc, L. Fácila Rubiod, P. Morillas Blascoe, S. Martínez Hervásf, V. Pascual Fusterg, F. Valls Rocah, C. Soler Portmanna,b, J.J. Tamarit Garcíai, V. Pallarés Carrataláj,k, MEJORA-LO CV Working Group
a Unidad de HTA y Riesgo Cardiometabólico, Servicio de Medicina Interna, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
b Departamento de Medicina Clínica, Facultad de Medicina, Universidad Miguel Hernández, Elche, Alicante, Spain
c Servicio de Medicina Interna, Hospital de La Plana, Villarreal (Castellón), Spain
d Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
e Servicio de Cardiología, Hospital General Universitario de Elche, Elche (Alicante), Spain
f Servicio de Endocrinología, Hospital Clínico Universitario de Valencia, Valencia, Spain
g Centro de Salud Palleter, Castellón, Spain
h Centro de Salud de Benigànim, Benigànim (Valencia), Spain
i Servicio de Medicina Interna, Hospital General Universitario, Valencia, Spain
j Unión de Mutuas, Castellón, Spain
k Departamento de Medicina, Universitat Jaume I, Castellón, Spain
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Members of the MEJORALO-CV workgroup , José María Cepeda Rodrigoaa, Juan Cosín Salesab, Rafael Durá Belinchónac, Enrique Gómez Segadoad, Saray Monleón Arenósae, Carlos Morillas Ariñoaf, Enrique Rodilla Salaag, Eduardo Rovira Daudíah, David Vicente Navarroai
aa Department of Internal Medicine, Hospital de la Vega Baja, Orihuela (Alicante), Spain
ab Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
ac Health Center of Godella, Godella (Valencia), Spain
ad Department of Internal Medicine, Hospital de la Marina Baja, Villajoyosa (Alicante), Spain
ae Health Center of Vinaroz, Vinaroz, Castellón, Spain
af Department of Endocrinology, University Hospital Doctor Peset, Valencia, Spain
ag Arterial Hypertension Unit, Department of Internal Medicine, Hospital of Sagunto, Sagunto (Valencia), Spain
ah Department of Internal Medicine, University Hospital La Ribera, Alzira (Valencia), Spain
ai Department of Internal Medicine, Hospital of Vinalopó, Elche (Alicante), Spain
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Figures (1)
Tables (4)
Table 1. Parameters employed by the respondents to establish treatment objectives.
Table 2. Self-perceived degree of lipid control by the respondents in the general population, patients with diabetes and patients in secondary prevention.
Table 3. Qualitative assessment of the main drug groups for managing dyslipidemia expressed as the score given by the respondents.
Table 4. Periodicity in conducting laboratory tests expressed as the time period stated by the respondents (% of responses).
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Additional material (1)
Abstract
Objective

To determine the management of dyslipidemia in primary care after the publication of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines and Valencian government's algorithm.

Method

We conducted a cross-sectional descriptive study that employed a survey of primary care physicians of the Community of Valencia between January and October 2016.

Results

A total of 199 physicians (mean age, 48.9±11.0 years; experience, 21.3±11.1 years) participated in the survey. The most followed guidelines were those of the European Society of Cardiology (37.5% of respondents) and Valencian government (23.4% of respondents). Some 6.3% of the respondents followed the 2013 ACC/AHA guidelines, and 88.0% established objectives based on LDL cholesterol and cardiovascular risk. The choice of lipid-lowering drug was based on its LDL cholesterol lowering capacity (28.6% of respondents), on the Valencian government's algorithm (23.4%) and on the drug's safety (20.4%). Statins, ezetimibe and fibrates were the preferred hypolipemiant agents, and their combination (51% of respondents) and dosage increases (35%) were the strategies employed for poor control. Lipid profile and transaminase and creatine kinase levels were measured every 6 (59.5%, 52.3% and 54.3% of respondents, respectively) or 12 months (25.1%, 29.2% and 30.3%, respectively). Forty-one percent of the respondents were aware of the controversy surrounding the 2013 ACC/AHA guidelines. Although 60% of the respondents acknowledged its relevance, only 21% changed their daily practices accordingly.

Conclusions

The Valencian government's algorithm had a greater impact than the 2013 ACC/AHA guidelines in primary care in Valencia. Areas for improvement included the low use of validated guidelines and risk tables and the streamlining of laboratory test periodicity.

Keywords:
Dyslipidemia
Statins
Primary care
Clinical practice guidelines
Resumen
Objetivo

Conocer el manejo de la dislipemia en atención primaria tras la publicación de la Guía de la American College of Cardiology/American Heart Association (ACC/AHA) del año 2013 y el algoritmo de la Administración.

Método

Estudio transversal descriptivo con encuesta a médicos de atención primaria de la Comunidad Valenciana entre enero y octubre de 2016.

Resultados

Participaron 199 facultativos con una media (desviación típica) de 48,9 (11) años de edad y 21,3 (11,1) años de experiencia. Las guías más seguidas eran las de la European Society of Cardiology (37,5%) y las de la Administración (23,4%). El 6,3% seguía la de la ACC/AHA 2013. El 88% establecía objetivos según colesterol LDL y riesgo cardiovascular. La elección del hipolipemiante estaba basada en su capacidad reductora de colesterol LDL (28,6%), algoritmo de la Administración (23,4%) y seguridad (20,4%). Estatinas, ezetimiba y fibratos eran los hipolipemiantes preferidos, y la combinación (51%) e incremento de dosis (35%) las estrategias en ausencia de control. Se determinaba perfil lipídico, transaminasas y creatincinasa cada 6 (59,5; 52,3 y 54,3%, respectivamente) o 12 meses (25,1; 29,2 y 30,3%, respectivamente). Un 41% era conocedor de la polémica con la Guía ACC/AHA 2013, y aunque un 60% reconocía su relevancia, solo un 21% modificó su quehacer diario por ella.

Conclusiones

El algoritmo de la Administración tuvo mayor impacto que la Guía ACC/AHA 2013 en atención primaria. Campos de mejora fueron el bajo uso de guías y tablas de riesgo validadas, y racionalización de la periodicidad de las analíticas.

Palabras clave:
Dislipemia
Estatinas
Atención primaria
Guía de práctica clínica

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