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P41 Background: Recurrent coronary events and mortality are  associated with elevated serum cholesterol levels in patients with  acute myocardial infarction (AMI). It’s unclear what physicians’  current attitudes and practices are toward the management of high  cholesterol levels in patients with recent AMI. We carried out a survey  of practicing physicians to examine factors that influence physicians  prescription of lipid-lowering and dietary therapy in patients with  recent AMI and threshold levels of cholesterol for intervention.  Methods: Mailed questionnaire survey of general internists,  cardiologists, and family physicians practicing and/or having admitting  privileges to all Worcester (MA) metropolitan hospitals. Results: Among  the 257 responding physicians, lipid lowering therapy was more likely  to be initiated in younger patients at lower total and LDL-cholesterol  levels than in older patients. Younger physicians were more likely to  initiate dietary and lipid lowering drug therapy at lower total and  LDL-cholesterol levels. General practice physicians were more likely to  initiate dietary therapy at lower total cholesterol levels, but more  likely to initiate lipid lowering drug therapy at higher total and  LDL-cholesterol levels, than internists and cardiologists. The most  important factors reported by physicians which interfered with  patient’s use of lipid lowering drug therapy were their concerns about  medication costs, issues related to polypharmacy, and failure to  recognize the importance of lipid lowering drugs. Several physician  associated factors including provider responsibility and importance of  other cardiac drugs were associated with the more widespread use of  these medications. Conclusions: Results of this survey in a  representative sample of community physicians suggest that older  physicians are less likely to implement recommended treatment  guidelines in patients with recent AMI and high cholesterol. Additional  efforts are needed to modify potential barriers to the implementation  of effective long-term cholesterol management in patients with recent  AMI.

Current Practices and Attitudes Toward Cholesterol Management in Patients With Recent Acute Myocardial Infarction: A Survey of Community Physicians