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Therapeutic Inertia in the Outpatient Management of Dyslipidemia in Patients With Ischemic Heart Disease. The Inertia Study

2010; Elsevier BV; Volume: 63; Issue: 12 Linguagem: Inglês

10.1016/s1885-5857(10)70277-2

1885-5857

Pablo Lázaro, Nekane Murga, Dolores Aguilar, Miguel Ángel Hernández-Presa,

Diabetes Management and Research

Studies indicate that dyslipidemia is undertreated. Numerous systematic reviews have shown that, even when therapeutic targets set by clinical practice guidelines have not been met, treatment remains unchanged despite the availability of alternatives approaches. The result is increased morbidity and mortality. Our aims were to investigate this phenomenon, known as therapeutic inertia, in patients with dyslipidemia and ischemic heart disease, and to determine its possible causes. Design: national, multicenter, observational study of data obtained from physicians by questionnaire and from the clinical records of patients with ischemic heart disease. Main variable: therapeutic inertia during a consultation, defined as treatment remaining the same despite a change being indicated (eg. low-density lipoprotein cholesterol >100 mg/dl or >70 mg/dl in diabetics). Covariates: physician, patient and consultation characteristics. Statistical analysis: multivariate logistic regression analysis of factors associated with therapeutic inertia during a consultation. Overall, 43% of consultations involved therapeutic inertia, and an association with coronary risk factors, including diabetes, did not result in a change in treatment. Therapeutic inertia occurred more frequently when there was a long time between the diagnosis and treatment of dyslipidemia and that of ischemic heart disease. Undertreatment was particularly common in women despite a greater overall risk. The more experienced physicians treated younger patients more appropriately. Clinical practice was improved by educational sessions at conferences. Therapeutic inertia was common in patients with chronic ischemic heart disease and dyslipidemia, irrespective of overall cardiovascular risk. Factors associated with the patient, disease and physician had an influence. Se ha descrito infratratamiento de las dislipemias. En sucesivas revisiones clínicas, aunque no se alcancen los objetivos terapéuticos marcados por las guías de práctica clínica, no se modifican los tratamientos a pesar de que se dispone de alternativas terapéuticas. Esta actitud, conocida como inercia terapéutica, produce un incremento de la morbimortalidad. Pretendemos medirla en pacientes con dislipemia y cardiopatía isquémica y analizar sus posibles causas. Diseño: estudio observacional multicéntrico nacional, con recogida de datos mediante cuestionario al médico y revisión de historias clínicas de pacientes con cardiopatía isquémica. Variable principal: inercia terapéutica en la visita, sin modificación de medicación a pesar de indicación de cambio (colesterol de las lipoproteínas de baja densidad > 100 mg/dl o > 70 mg/dl en diabéticos). Covariables: del médico, del paciente y de la visita. Análisis estadístico: estudio multivariable de regresión logística de los factores asociados a la inercia terapéutica en la visita. En un 43% de las visitas se actúa con inercia terapéutica; la asociación con factores de riesgo coronario, incluida la diabetes, no motiva cambio del tratamiento. La inercia terapéutica está favorecida por un mayor tiempo desde el diagnóstico y el tratamiento de la dislipemia y de la cardiopatía isquémica. Las mujeres están especialmente infratratadas a pesar de un mayor riesgo total. Los médicos más experimentados tratan mejor a los pacientes más jóvenes. La formación en congresos mejora la práctica clínica. Elevada inercia terapéutica en pacientes con cardiopatía isquémica crónica y dislipemia, independientemente del riesgo cardiovascular total. Intervienen factores dependientes del paciente, de la enfermedad y del médico.