PHYSICIAN NONCOMPLIANCE WITH THE 1993-NATIONAL-CHOLESTEROL-EDUCATION-PROGRAM (NCEP-ATPII) GUIDELINES

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 hyperlipidem ia. Methods and Results-We conducted a retrospective chart review on r andomly sampled charts of 225 patients admitted to the coronary care u nit between January and June 1996, The main outcome measures were rate s of physician screening for coronary heart disease risk factors; rate s of counseling for cigarette cessation, diet, and exercise; and exten t of use of NCEP algorithms for obtaining LDL cholesterol values and t reating hypercholesterolemia. Screening rates for interns (who perform ed best) were: cigarette use (89%), known coronary heart disease (74%) , hypertension (68%), hyperlipidemia (59%), family history (56%), diab etes (37%), postmenopausal hormone therapy (11%), and premature menopa use (1%). Four percent of smokers were counseled to quit, 14% of patie nts were referred to dietitians, and 1% were encouraged to exercise. A full lipid panel was obtained in 50% of patients in whom it was indic ated on the basis of NCEP criteria. Patients were more likely to recei ve lipid-lowering treatment if NCEP criteria indicated that they shoul d, but 36% of hospitalized patients and 46% of patients who should hav e been treated on discharge were not. Conclusions-Physicians are poorl y compliant with NCEP guidelines for risk factor assessment and counse ling, even in patients at high risk for coronary heart disease. Physic ians follow NCEP-ATPII algorithms for obtaining an LDL value, a key st ep in evaluating the need for treatment, only 50% of the time. NCEP cr iteria seem to influence the decision to initiate lipid-lowering thera py, but significant numbers of eligible patients remain untreated.