Physician noncompliance with the 1993 National Cholesterol Education Program (NCEP-ATPII) guidelines

Joseph P. Frolkis, Stephen J. Zyzanski, Jonathan M. Schwartz, Pamela S. Suhan

Research output: Contribution to journalArticle

173 Citations (Scopus)

Abstract

Background - We sought to determine the frequency with which physicians follow National Cholesterol Education Program (NCEP-ATPII) guidelines in screening for cardiovascular risk factors and treating hyperlipidemia. Methods and Results - We conducted a retrospective chart review on randomly sampled charts of 225 patients admitted to the coronary care unit between January and June 1996. The main outcome measures were rates of physician screening for coronary heart disease risk factors; rates of counseling for cigarette cessation, diet, and exercise; and extent of use of NCEP algorithms for obtaining LDL cholesterol values and treating hypercholesterolemia. Screening rates for interns (who performed best) were: cigarette use (89%), known coronary heart disease (74%), hypertension (68%), hyperlipidemia (59%), family history (56%), diabetes (37%), postmenopausal hormone therapy (11%), and premature menopause (1%). Four percent of smokers were counseled to quit, 14% of patients were referred to dietitians, and 1% were encouraged to exercise. A full lipid panel was obtained in 50% of patients in whom it was indicated on the basis of NCEP criteria. Patients were more likely to receive lipid-lowering treatment if NCEP criteria indicated that they should, but 36% of hospitalized patients and 46% of patients who should have been treated on discharge were not. Conclusions - Physicians are poorly compliant with NCEP guidelines for risk factor assessment and counseling, even in patients at high risk for coronary heart disease. Physicians follow NCEP-ATPII algorithms for obtaining an LDL value, a key step in evaluating the need for treatment, only 50% of the time. NCEP criteria seem to influence the decision to initiate lipid-lowering therapy, but significant numbers of eligible patients remain untreated.

Original languageEnglish (US)
Pages (from-to)851-855
Number of pages5
JournalCirculation
Volume98
Issue number9
StatePublished - Sep 1 1998
Externally publishedYes

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Cholesterol
Guidelines
Physicians
Education
Coronary Disease
Hyperlipidemias
Lipids
Tobacco Products
Counseling
Premature Menopause
Exercise
Coronary Care Units
Nutritionists
Therapeutics
Hypercholesterolemia
LDL Cholesterol
Outcome Assessment (Health Care)
Hormones
Diet
Hypertension

Keywords

  • Compliance
  • Lipoproteins
  • Practice guidelines
  • Risk factors

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Physician noncompliance with the 1993 National Cholesterol Education Program (NCEP-ATPII) guidelines. / Frolkis, Joseph P.; Zyzanski, Stephen J.; Schwartz, Jonathan M.; Suhan, Pamela S.

In: Circulation, Vol. 98, No. 9, 01.09.1998, p. 851-855.

Research output: Contribution to journalArticle

Frolkis, Joseph P. ; Zyzanski, Stephen J. ; Schwartz, Jonathan M. ; Suhan, Pamela S. / Physician noncompliance with the 1993 National Cholesterol Education Program (NCEP-ATPII) guidelines. In: Circulation. 1998 ; Vol. 98, No. 9. pp. 851-855.
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