Meeting Real-World Challenges in Cardiovascular Disease Risk Management: A Pan-European Crowdsourcing Activity

 
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Declarative information
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* Mandatory
1. Please indicate the number of patients you manage for primary or secondary prevention of cardiovascular disease (CVD) risk per year. This may include provision of lifestyle interventions, prescription drugs, referral to specialist services or cardiovascular interventions such as stent implantation.

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2. How much time do you typically spend with patients managing CVD prevention during a typical consultation?

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3. Do you predominantly work in primary or secondary care?

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3.1. What is your primary role?

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3.2. Do you have a special interest?

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3.3. Thinking of your practice, which of the following best describes the predominant demographic of the patients you see for the management of established CVD or at increased CVD risk?
a. Age

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b. Native language

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c. Economic grouping

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3.4. Thinking of the nature of your main practice, is this a state-run institution or a private clinic?

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3.1. What is your primary role?

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Please enter your primary role

3.2. What is the nature of your practice?

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3.3. Thinking of the nature of your main practice, is this a state-run institution or a private clinic?

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4. What guidelines do you use with respect to managing ASCVD risk? (Indicate your main guideline.)

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Please enter your please enter international guidelines you use

Please enter your please enter national or local guidelines you use

CVD risk
5. In the following patient profiles, select which risk category they represent and which lipid-lowering approach you would take.
I. Age 41, female; LDL 1.8 mmol/L (70 mg/dL); type 2 diabetes (diagnosed 6 years ago); CKD (50 mL/min/1.73 m2) with microalbuminuria (ACR 35 mg/g); no prior CV events reported. On low-dose statin, metformin + SGLT-2 inhibitor, ACE inhibitor.
A. Select what risk category this patient fits.

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B. Which lipid-lowering approach would you use in this patient?

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C. What LDL-C goal would you recommend for this patient?

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II. Age 60, male; LDL 1.9 mmol/L (73 mg/dL); multiple prior CV events reported (NSTEMI with successful PCI). On high-dose statin (max dose), ACE inhibitor + CCB.
A. Select what risk category this patient fits.

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B. Which lipid-lowering approach would you use in this patient?

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C. What LDL-C goal would you recommend for this patient?

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III. Age 54, male; LDL 3.5 mmol/L (135 mg/dL); familial hypercholesterolaemia; no prior CV events reported. On moderate intensity statin.
A. Select what risk category this patient fits.

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B. Which lipid-lowering approach would you use in this patient?

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C. What LDL-C goal would you recommend for this patient?

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IV. Age 43, female; LDL 3.0 mmol/L (117 mg/dL); hospitalised with ACS (NSTEMI) and treated with stent. Currently on no lipid-related treatment.
A. Select what risk category this patient fits.

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B. Which lipid-lowering approach would you use in this patient?

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C. What LDL-C goal would you recommend for this patient?

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V. Age 30, female; LDL 5.0 mmol/L (193 mg/dL); familial hypercholesterolaemia; no events reported but father had MI; sedentary lifestyle but no further risk factors. Currently on no lipid-lowering therapy or any other medications.
A. Select what risk category this patient fits.

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B. When would you consider starting lipid-lowering treatment in this patient?

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C. What LDL-C goal would you recommend for this patient?

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VI. Age 50, male; LDL 1.0 mmol/L (40 mg/dL); diagnosed with type 2 diabetes 2 years ago (HbA1c at target with metformin and a DPP-4 inhibitor) and a current smoker. Had a MI around one year ago (LDL 2.3 mmol/L [85 mg/dL]) and initiated on high dose statin + ezetimibe in hospital; no further events reported since.
A. Select what risk category this patient fits.

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B. Which lipid-lowering approach would you use in this patient?

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C. What LDL-C goal would you recommend for this patient?

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CVD risk assessment in practice
6. When estimating total CVD risk, which system do you most commonly use?

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Please state the system you most commonly use

6.1. In which adult patients do you carry this out?

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Please provide details about your patients

7. On a scale of 1 – 5, with 1 being poor and 5 being excellent, indicate your current perceived level of knowledge on assessing total CVD risk.

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Lipid-lowering therapies
8. What is your therapy of choice for a patient whose therapeutic LDL-C target is not reached with the highest tolerated statin dose with/without ezetimibe notwithstanding contraindications and pricing/reimbursement barriers?

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Please enter your therapy of choice

9. What is your therapy choice for a patient who has achieved their therapeutic LDL-C goal but their triglyceride level is elevated (2.5 mmol/L [221 mg/dL]), and are at high risk, notwithstanding contraindications and pricing/reimbursement barriers?

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Please enter your preferred therapy choice

10. Which of the following factors influence your decision to prescribe the above? Please indicate the relative importance of each on the scale of 1 – 5, with 1 being not important/not applicable and 5 being very important.
i. Clinical judgement

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ii. RCT evidence of efficacy

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iii. RCT evidence of safety

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iv. Compliance with local protocols

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v. Guideline recommendation

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vi. Cost/availability

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vii. Reimbursement

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viii. Risk classification

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Lipid-lowering therapies - continued
11. What is your general level of knowledge on the following classes of medications, used in individuals who have not reached their LDL-C goal despite highest tolerable dose of statin?
i. Ezetimibe

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ii. PCSK9 monoclonal antibody inhibitors

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iii. RNAi for PCSK9 synthesis (inclisiran)

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iv. Bempedoic acid

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v. A fibrate

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vi. An n-3 fatty acid (eicosapentaenoic acid or docosahexaenoic acid)

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12. What is your perception of the current European guideline recommended targets for LDL-C, as set out in the publication ‘2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk’?

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13. Which of the following best describes your current attitude towards the LDL-C targets as described in your preferred lipid-lowering guidance?

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Achieving LDL-C goals and education
14. What do you perceive to be the biggest obstacle faced by patients for adhering to their lipid-lowering medication from the following?

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Please enter what you perceive to be the biggest obstacle faced by patients

15. How frequently do you assess adherence to lipid-lowering therapy in your patients?

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16. Are you confident in providing adequate education to your patients on achieving LDL-C targets?

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17. Do you provide education for your patients around the general management of CVD risk?

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17.1. How does this predominantly take place?

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17.2. Generally, how frequently does this take place?

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17.3. Which concepts do you use to communicate to your younger patients (<40 yrs) about their risk of CVD? (Select all that apply.)

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Please enter the concepts you use

18. If a patient who is currently at their LDL-C goal receiving 40 mg atorvastatin but wants to stop due to myalgia, what is your initial response?

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Once you press 'Submit', you will no longer be able to amend your answers.


Before you start

The aim of this project is to capture the insight and practices of prescribers from across Europe on the management of cardiovascular disease (CVD) risk. By doing so, we aim to gain a better understanding the main barriers precluding optimal management of patients at increased CVD risk

As such the following survey questions will ask about:

  • How you assess CVD risk
  • Your current use of lipid-lowering therapies
  • Achieving LDL-C goals
  • Provision of patient education
  • Knowledge of therapies and guidelines

Important

Please read all instructions in the header of each question.

A glossary of abbreviations and definitions can be accessed by clicking the styled text.

Time commitment and instructions

There are a total of 18 questions split into sub-questions.

We anticipate this will take 15-20 minutes to complete. You can do this in one setting or can save your responses at the bottom of each page and come back to finish any time whilst the survey is open by just re-entering your email address on this page.

Please ensure you complete and submit all answers by 31st December when the survey will close.

Please complete all free-type answers in English.

If you have not answered a mandatory question you will not be able to move on. This question will appear in red on screen for you to complete.

You can use the 'Back' button located at the bottom of each page to go back and review your previous answers at any time.

Ongoing recruitment

If you have colleagues who would like to take part in the survey you can simply send this link:
https://cvd.crowdsourcing.radcliffeeducation.com/join-cs21?_ms=136325&_msai=shareJoinLP

Thank you

On behalf of the Executive Steering Committee, Advisory Board and Radcliffe Medical Education Project Team, thank you for agreeing to take part in this ambitious project.

This research has been made possible by an unrestricted educational grant from Novartis and is endorsed by the International Society of Cardiovascular Pharmacotherapy (ISCP). Radcliffe Medical Education have provided content, organisational and logistical support.