Abstract 14283: Patient Perceptions About Lipid-Lowering Therapy and Treatment Goals: Insights From a Survey of Patients With Established ASCVD Participating in the Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD) Registry
Circulation
Abstract
Background: Recent guidelines and consensus pathways on management of cholesterol emphasize the role of patient-centered shared decision making in management of cholesterol. However, patient-reported understanding of lipid-lowering therapy (LLT) benefits, risks, and treatment goals have not been well-described.
Methods: From December 2016 to April 2018, interactive phone surveys were conducted in the 4444 patients across the 120 US centers participating in the Getting to an imprOved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD) registry. Patients with ASCVD receiving any pharmacologic LLT were eligible for enrollment in 1 of 3 cohorts: currently receiving a PCSK9 inhibitor (PCSK9i) antibody (~550 patients), no PCSK9i and LDL-C 70-99 mg/dL (~2650 patients), or ≥100 mg/dL (~1800 patients).
Results: Patients in the PCSK9i cohort vs. those in the LDL-C 70-99 or ≥100 mg/dL groups were significantly more likely to have a college degree (44% vs. 36% and 31%), household income ≥$75K/yr (38% vs. 27% and 24%), private insurance (38% vs. 28% and 32%), engage in regular exercise (60% vs. 52% and 47%), and have cholesterol managed by a cardiologist (59% vs. 36% and 33%), respectively (all p < 0.001). Overall, >70% of patients were not aware that the main goal of LLT was prevention of ASCVD events, >50% did not realize that heart disease was the main cause of death in women (and ~40% in men); nearly half were unaware of their total lipid or LDL-C levels, and a majority did not know their 10-year ASCVD risk or treatment goals. Patients on a PCSK9i were significantly more likely to report prior statin-related symptoms (82% vs. 24% and 38%), and (of those not on statins) were less likely to be willing to restart statins (14% vs. 58% and 31%, respectively; all p<0.001).
Conclusion: Among patients with ASCVD, those treated with PCSK9i represent a select group, with higher socioeconomic status and prevalence of healthy lifestyle, greater access to specialty care, and more statin intolerance. Regardless of LLT type, a large proportion of patients remain unaware of their ASCVD risk, LDL-C levels, or therapy goals, highlighting an educational gap which, if addressed, may impact shared decision-making and treatment adherence.
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© 2018 by American Heart Association, Inc.
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Published online: 5 November 2018
Published in print: 6 November 2018
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