Hands and feet

September 2009

Research

Statin initiation by GPs in WA

A structured vignette study

Volume 38, No.9, September 2009 Pages 739-742

Leanne Stafford

Nichola Harmer

Satvinder Dhaliwal

Moyez Jiwa

Background

Statins are recommended for all patients with known coronary heart disease. This pilot study investigated statin initiation by a Western Australian general practitioner cohort and the influence of prescriber and patient characteristics on prescribing.

Methods

A structured vignette questionnaire was posted to members of the Fremantle GP Network. Respondents indicated their prescribing decisions for nine hypothetical patients who had recently suffered a myocardial infarction. Data analysis utilised logistic regression analyses and a generalised linear model with a logit link function.

Results

Fifty-five GPs responded (16.0% response rate). In over 20% of cases a statin was not prescribed. Male (OR 4.71; 95% CI: 1.24–17.87) and GPs with fewer years in practice (4.50; 1.21–16.77) were more likely to prescribe appropriately. Younger patients (2.21; 1.38–3.53), and those with diabetes (1.74; 1.09–2.76) or hypercholesterolaemia (4.81; 2.88–8.03) were more likely to receive therapy.

Discussion

Prescribing practices failed to comply with current guidelines in a significant number of cases. Further research to confirm these findings is warranted.

The National Heart Foundation of Australia (NHF) and the Cardiac Society of Australia and New Zealand Reducing Risk in Heart Disease 2007 guidelines state that ‘statin therapy is recommended for all patients with coronary heart disease (apart from in exceptional circumstances)’.1 This recommendation is supported by the results of numerous randomised controlled clinical trials: statins (HMG-CoA reductase inhibitors) have been shown to be of benefit in the secondary prevention of cardiovascular disease in patients with documented dyslipidaemia, those with previously ‘normal’ cholesterol levels and also in elderly patients.2–4 Early initiation of statins in the management of acute coronary syndromes (ACS ) has been proven to offer additional benefits.5,6

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Correspondence afp@racgp.org.au

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