European Physician Survey Characterizing the Clinical Pathway and Treatment Patterns of Patients Post-Myocardial Infarction

Qureshi, Nadeem; Antoniou, Sotiris; Cornel, Jan H.; Schiele, Francois; Perrone-Filardi, Pasquale; Brachmann, Johannes; Sidelnikov, Eduard; Villa, Guillermo; Ferguson, Samara; Rowlands, Christina; González-Juanatey, José R.

Abstract

Introduction: The 2019 European Society of Cardiology and European Atherosclerosis Society (2019 ESC/EAS) guidelines stress the importance of managing low-density lipoprotein cholesterol (LDL-C) after myocardial infarction (MI) to reduce the risk of cardiovascular events. Information on guideline implementation is limited. The aim of this survey was to describe current clinical practice regarding LDL-C management in the first year post-MI across Europe, improving understanding of the role of ESC/EAS guidelines on clinical practice. Methods: A qualitative web-based cross-sectional physician survey about the patient pathway and LDL-C management post-MI was conducted in 360 physicians from France, Italy, Germany, The Netherlands, Spain, and the UK (n = 60/country) between December 2019 and June 2020. Secondary and primary care physicians (SCPs/PCPs) described their experiences treating patients post-MI over the preceding 2months. Results: Physicians reported that on average 90.7% of patients not prescribed lipid-lowering therapy (LLT) before an MI initiated LLT as inpatients; for patients already taking LLT, treatment was intensified for 64.7% of inpatients post-MI. SCPs reported prescribing higher-intensity statins and/or ezetimibe for between 72.3% (Italy) and 88.6% (UK) of patients post-MI. More than 80.0% of SCPs and 51.2% of PCPs stated that they would initiate a change in LLT immediately if patients did not achieve their LDL-C treatment goal by 12weeks post-MI; 82.0% of SCPs and 55.1% of PCPs reported referring to 2019 ESC/EAS guidelines for management of patients post-MI. Barriers to initiating PCSK9 inhibitors (PCSK9is) included prior prescription of a maximally tolerated dose of statin (49.4%) and/or ezetimibe (38.9%), requirement to reach threshold LDL-C levels (44.9%), and pre-authorization requirements (30.4%). Conclusion: Differences in clinical practice post-MI were reported across the countries surveyed, including divergence between 2019 ESC/EAS and local guidelines. Increased use of innovative medicines to achieve LDL-C goals should reduce risk of subsequent cardiovascular events in very high-risk patients post-MI.

Citation

Qureshi, N., Antoniou, S., Cornel, J. H., Schiele, F., Perrone-Filardi, P., Brachmann, J., …González-Juanatey, J. R. (2022). European Physician Survey Characterizing the Clinical Pathway and Treatment Patterns of Patients Post-Myocardial Infarction. Advances in Therapy, https://doi.org/10.1007/s12325-022-02344-6

• Journal Article Type: Article
• Acceptance Date: Sep 29, 2022
• Online Publication Date: Oct 26, 2022
• Publication Date: Oct 26, 2022
• Deposit Date: Nov 2, 2022
• Publicly Available Date: Nov 2, 2022
• Journal: Advances in Therapy
• Print ISSN: 0741-238X
• Electronic ISSN: 1865-8652
• Publisher: Springer Science and Business Media LLC
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1007/s12325-022-02344-6
• Keywords: Pharmacology (medical); General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/13174522
• Publisher URL: https://link.springer.com/article/10.1007/s12325-022-02344-6