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Impact of Implementing a Dyslipidemia Management Guideline on Cholesterol Control for Secondary Prevention of Ischemic Heart Disease in Primary Care

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Equip d’Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
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Programa de Doctorat en Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
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GAVINA Research Group, 43500 Tortosa, Tarragona, Spain
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Equip d’Atenció Primària Tortosa Est, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
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Programa de Doctorat de Biomedicina, Universitat Rovira i Virgili, 43201 Reus, Spain
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Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
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Departament de Cardiologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
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Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
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Departament de Patologia, Hospital de Tortosa Verge de la Cinta, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
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Institut d’Investigació Sanitària Pere Virgili (IISPV), 43500 Tortosa, Tarragona, Spain
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Departament d’Infermeria, Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Tarragona, Spain
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Authors to whom correspondence should be addressed.
Co-senior authors.
Int. J. Environ. Res. Public Health 2020, 17(22), 8590; https://doi.org/10.3390/ijerph17228590
Received: 1 October 2020 / Revised: 16 November 2020 / Accepted: 17 November 2020 / Published: 19 November 2020
Cardiovascular diseases (CVD) are the main cause of death worldwide. The control of CVD risk factors, such as dyslipidemia, reduces their mortality rate. Nonetheless, fewer than 50% of patients with ischemic heart disease (IHD) have good cholesterol control. Our objective is to assess whether the level of participation of general practitioners (GPs) in activities to implement a dyslipidemia management guideline, and the characteristics of the patient and physician are associated with cholesterol control in IHD patients. We undertook a quasi-experimental, uncontrolled, before-and-after study of 1151 patients. The intervention was carried out during 2010 and 2011, and consisted of a face-to-face training and online course phase (Phase 1), and another of face-to-face feedback (Phase 2). The main outcome variable was the low-density lipoprotein cholesterol (LDL-C) control, whereby values of <100 mg/dL (2.6 mmol/L) were set as a good level of control, according to the recommendations of the guidelines in force in 2009. After Phase 1, 6.7% more patients demonstrated good cholesterol control. With respect to patient characteristics, being female and being older were found to be risk factors of poor control. Being diabetic and having suffered a stroke were protective factors. Of the GPs’ characteristics, being tutor in a teaching center for GP residents and having completed the online course were found to be protective factors. We concluded that cholesterol control in IHD patients was influenced by the type of training activity undertook by physicians during the implementation of the GPC, and patient and physician characteristics. We highlight that if we apply the recent targets of the European guideline, which establish a lower level of LDL-C control, the percentage of good control could be worse than the observed in this study. View Full-Text
Keywords: practice guideline; cholesterol; secondary prevention; ischemic heart disease; primary health care practice guideline; cholesterol; secondary prevention; ischemic heart disease; primary health care
MDPI and ACS Style

Forcadell Drago, E.; Dalmau Llorca, M.R.; Aguilar Martín, C.; Ferreira-González, I.; Hernández Rojas, Z.; Gonçalves, A.Q.; López-Pablo, C. Impact of Implementing a Dyslipidemia Management Guideline on Cholesterol Control for Secondary Prevention of Ischemic Heart Disease in Primary Care. Int. J. Environ. Res. Public Health 2020, 17, 8590. https://doi.org/10.3390/ijerph17228590

AMA Style

Forcadell Drago E, Dalmau Llorca MR, Aguilar Martín C, Ferreira-González I, Hernández Rojas Z, Gonçalves AQ, López-Pablo C. Impact of Implementing a Dyslipidemia Management Guideline on Cholesterol Control for Secondary Prevention of Ischemic Heart Disease in Primary Care. International Journal of Environmental Research and Public Health. 2020; 17(22):8590. https://doi.org/10.3390/ijerph17228590

Chicago/Turabian Style

Forcadell Drago, Emma, Maria R. Dalmau Llorca, Carina Aguilar Martín, Ignacio Ferreira-González, Zojaina Hernández Rojas, Alessandra Q. Gonçalves, and Carlos López-Pablo. 2020. "Impact of Implementing a Dyslipidemia Management Guideline on Cholesterol Control for Secondary Prevention of Ischemic Heart Disease in Primary Care" International Journal of Environmental Research and Public Health 17, no. 22: 8590. https://doi.org/10.3390/ijerph17228590

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