One Year On: Survey Of GP Opinion On The Impact Of NICE Guidelines On CHD Risk, UK

Main Category: Cardiovascular / Cardiology
Also Included In: Diabetes
Article Date: 19 Aug 2009 - 1:00 PDT

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One year after the publication of the NICE Lipid Modification (CG67) and Type 2 Diabetes (CG66) Guidelines, a new survey of 400 UK healthcare professionals, conducted by TNS Healthcare UK and sponsored by Merck Sharp & Dohme Limited and Schering-Plough Limited has revealed that the majority of GPs recognise the important role played by these guidelines in reducing the level of coronary heart disease (CHD) risk among UK patients over the last year.

Of the GPs surveyed (n=100), over half (57%)3 reported that the NICE Lipid Modification Guideline has played an important role in reducing the level of CHD risk among UK patients over the past year and up to two thirds (66%)3 felt that the Type 2 Diabetes Guideline has played the same role.

GP support for the guidelines (CG67 and CG66) is further highlighted by the survey results, with seven out of ten of the GPs surveyed (77% and 73% respectively) considering the NICE lipid targets (<4mmol/L total cholesterol and/or <2mmol/L LDL-cholesterol) to be best practice in terms of lipid management for secondary prevention and type 2 diabetes patients.

In order to reach these lipid targets, eight out of ten (80%) GPs reported that more effective treatments, beyond simvastatin 40mg, are necessary for patients with type 2 diabetes and 76% felt that secondary prevention patients would also benefit from more effective treatments beyond simvastatin 40mg - the initial statin treatment recommended by NICE.

Dr Mike Kirby, a GP in Hertfordshire with an interest in CVD, commented "It is encouraging to see from this survey that many GPs welcome the NICE lipid targets but it is concerning that some feel they are not able to treat to this standard. Simvastatin 40mg is an effective first-line treatment but it is not realistic for all high-risk patients to achieve the best practice NICE lipid targets on this treatment alone. Additional lipid lowering treatments available to GPs, such as changing to a more potent statin or adding in ezetimibe, should be considered."

In spite of the guidelines and available treatments, over half of GPs surveyed (65% and 55% respectively) said that they managed most of their secondary prevention and type 2 diabetes patients to the less stringent QOF audit standard of <5mmol/L total cholesterol.

Dr Mike Kirby added, "The link between reducing cholesterol - in particular LDL-C - and reducing the risk of CHD is well established. The Joint British Societies' guidelines (JBS 2) set the precedent for lower cholesterol targets in high risk patients back in 2005, which the NICE guidelines have since reflected. GP support for the NICE guidelines is therefore unsurprising, however it is now vitally important that they feel supported to fully implement them."

GP poll

The top five barriers to reaching NICE recommended lipid levels (<4mmol/L total cholesterol and/or <2mmol/L LDL-cholesterol) in high-risk patients:

- Cost of implementing the guidelines - 46%
- Number of guidelines - 42%
- Time pressures - 38%
- Limited resources to support implementation of the NICE guidelines - 34%
- Limited awareness of the guidelines - 15%

Sources
Merck Sharp & Dohme and Schering-Plough