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Does Management of Lipid Lowering Differ Between Specialists and Primary Care: Insights from GOAL Canada.
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  • Anatoly Langer,
  • Mary Tan,
  • Shaun Goodman,
  • Jean Gregoire,
  • Peter Lin,
  • John Mancini,
  • James Stone,
  • Lawrence Leiter
Anatoly Langer
Canadian Heart Research Centre
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Mary Tan
Canadian Heart Research Centre
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Shaun Goodman
St Michael's Hospital
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Jean Gregoire
Université de Montréal, Institut de cardiologie de Montréal
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Peter Lin
Canadian Heart Research Centre
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John Mancini
UBC
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James Stone
Cumming School of Medicine, University of Calgary; Libin Cardiovascular Institute of Alberta
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Lawrence Leiter
St Michael’s Hospital and University of Toronto
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Abstract

Background: We studied whether significant differences in care gaps exist between specialists and PCPs. Methods: GOAL Canada enrolled patients with CVD or familial hypercholesterolemia (FH) and LDL-C > 2.0 mmol/L despite maximally tolerated statin therapy. During follow-up, physicians received online reminders of treatment recommendations based on Canadian Guidelines. Results: A total of 177 physicians (58% PCPs) enrolled 2009 patients; approximately half of the patients were enrolled by each physician group. Patients enrolled by specialists were slightly older (mean age 63 years vs. 62), female (45% vs. 40%), Caucasian (77% vs. 65%), and had a slightly higher systolic pressure and lower heart rate. Patients enrolled by specialists had less frequent history of familial hypercholesterolemia, diabetes, hypertension, chronic kidney disease and liver disease but more frequent history of coronary artery disease, atrial fibrillation and premature family history of CVD. There was no significant baseline difference in LDL-C, HDL-C, or non-HDL-c, although total cholesterol and triglycerides were slightly higher in patients managed by PCPs. At baseline, PCPs were more likely to use statins (80% vs.73%, p=0.0002) and other therapies such as niacin or fibrate (10% vs. 6%, p=0.0006) but similar use of ezetimibe (24% vs. 27%, p=0.15). At the end of follow up, specialists used less statins (70% vs. 77%, p=0.0005) and other therapies (6% vs. 10%, p=0.007) but more ezetimibe (45% vs. 38%, p=0.01) and the same frequency of PCSK9i (28% vs. 27%, p=0.65). The proportion of patients achieving the recommended LDL-C level of 2.0 mmol/L or below (primary endpoint) was similar at last available visit between specialists and PCPs (44% vs. 42%, p=0.32). Conclusion: Despite minor differences in the clinical profile of their patients, both PCPs and specialists actively participate in the management of lipid lowering therapy in high risk CVD patients and experience similar challenges and care gaps.

Peer review status:Published

02 Oct 2020Submitted to International Journal of Clinical Practice
03 Oct 2020Submission Checks Completed
03 Oct 2020Assigned to Editor
04 Oct 2020Reviewer(s) Assigned
26 Oct 2020Review(s) Completed, Editorial Evaluation Pending
31 Oct 20201st Revision Received
01 Nov 2020Submission Checks Completed
01 Nov 2020Assigned to Editor
01 Nov 2020Reviewer(s) Assigned
18 Nov 2020Review(s) Completed, Editorial Evaluation Pending
20 Nov 2020Editorial Decision: Accept
Apr 2021Published in International Journal of Clinical Practice volume 75 issue 4. 10.1111/ijcp.13861