2010 Survey
The National Lipid Association
• Non-profit organization
• Directed toward advocacy for the education of health care
professionals involved in the diagnosis and treatment of
lipoprotein disorders and related metabolic diseases
• Developed in 1997 as outgrowth of Southeast Lipid
Association by a group of lipid researchers and clinicians
from southeastern U.S.
• 5 regional chapters
• Approximately 2500 active members in 2010
LIPID PULSE Objectives
• To better understand the practice dynamics, beliefs and
behaviors of HCPs who specialize in lipid management
• To delineate the differences between respondents
according to their practice’s degree of focus on lipid
management
• To understand the awareness and utilization of various lipid
parameters & information sources
• To understand the value NLA members place on NLA
offerings
3
1. Lipid Pulse Membership Survey:
• Survey Design
• Survey Market Promotion
• Methodology
• Respondent Groupings
4
Survey Design
• On-line, ~30-Question survey that took ~13 minutes to complete
• Developed, programmed, tested and launched by a team including representatives
from Genzyme, NLA staff, NLA Board Leadership and Reckner/Blueberry
Clinician Information
Practice Information
Lipid Management
Patient Information
Information Services
NLA Membership
Survey Promotional Efforts
• Target List: 2,581 NLA members (2,490 w/ email)
• Honorarium / Incentive language:
• The NLA is conducting a membership survey to get to know you and your practice better.
When you complete the survey, you'll receive a $25 voucher to use on NLA products, a report
of the survey results, and 25 copies of the Genzyme-published patient education booklet on
Familial Hypercholesterolemia. Help us achieve 100% participation!”
• Recruited: through email, fax, mail from May 11th to June 2nd; survey closed June 14th
• Key Activities:
– May 11th: An initial email & mail invitation was sent to all members with a valid email
or mailing address
• Timed to coincide with the NLA Scientific Sessions in Chicago, May 13-16 2010 where kiosk
was present (attendees could take survey via kiosk or smartphone)
– May 20th: Follow-up email, fax, and USPS mailed invitation was sent to members
who did not respond to the initial email or USPS invite.
• Also, a reminder invitation was sent (via email or fax) to those members who started the
survey but did not complete the survey
– June 2nd: A second follow-up email and fax invitation was sent to members who had
not yet participated.
• Also, a reminder invitation was sent (via email or fax) to those members who started the
survey but did not complete the survey
6
Daily Responses vs. Promotional Activity
Respondents
Total = 674
140
# of Respondents
120
100
80
60
40
20
0
A star indicates a promotional activity occurred on this date (e.g., email/fax communication,
USPS mailing)
7
Methodology
– 657 valid survey responses
– 17 respondents were removed due to industry employment
– Pairwise comparisons between groups were tested at the 95% and 80%
confidence interval throughout report
– Charts, graphs and tables indicate comparisons that were significant at the 95%
confidence level, using uppercase letters to denote columns against which
comparisons were significant
– Comparisons significant at the 80% confidence interval are denoted using lowercase
letters
– Note small base sizes of < n=30; interpret with caution
8
Respondent Groupings
– Respondents grouped according to self-reported:
– Profession (e.g., Physicians, NPs/PAs, Pharmacists or other)
– Specialty* (e.g., IM/GP, Cardiologists, Endocrinologists or other)
– Lipid Practice Profile
• Which best describes the role lipid management (plays) in your
practice? My practice is a…
a) Lipid Clinic (i.e. staff and time specifically dedicated to seeing
patients for lipid disorders)
b) Lipid Specialist Practice (i.e. not a Lipid Clinic, but receive patient
referrals from other clinicians for patients specifically for lipid
management)
c) [neither] Lipid management is incorporated into my clinical practice,
but I do not work at a Lipid Clinic, nor do I receive referrals specifically
for lipid problems (i.e. neither a nor b)
* Only applies to MDs & NPs/PAs
9
2. Respondent & Practice Profile
• Geographic Distribution
• Profession, Specialty & Lipid Practice
Profile
• Years in Practice
• Practice Setting
• Lipid Certification Status
10
Geographic Distribution - All Respondents*
* n=630 (27 respondents excluded because of undetermined addresses or international)
Geographic Distribution – By Lipid
Practice Profile*
Lipid Clinic
Lipid Specialist
* n=628 (29 respondents excluded because of undetermined addresses or international respondents)
Other NLA Respondent
Lipid Clinic Respondents Only*
* n=137
Geographic Distribution:
Summary
• Lipid specialists tend to be clustered in urban
areas
• Highest density of lipid clinics is seen in
regions where initial NLA chapters were
started: southwest, midwest and northeast
Respondents by Profession
• Of the 657 respondents who completed the survey, 67% are physicians, 16%
are NPs/PAs and 8% are pharmacists
– “Other” includes PhD/scientists, Nurses (4%), Registered Dieticians/nutritionists (RD)
(4%), Ph.D. or science specialists (2%) and Certified Diabetes Educator (CDE) (<1%).
Profession
% of Respondents
100%
80%
67%
60%
40%
16%
20%
8%
10%
PHARM
Other
0%
PHYS
(n=439)
NP/PA
(n=102)
(n=53)
(n=63)
Base: All Respondents (n=657)
Q1 Please indicate your profession (select one): (Are you a) Physician (MD/DO) Nurse Practitioner (NP), Physician’s Assistant (PA) , Dietician (RD), Exercise specialist,
Pharmacist, Ph.D. or science specialty, Certified Diabetes Educator (CDE) or Other: (Please specify)?
15
Respondents by Specialty
• About half of physician respondents are self-report as IMs or FPs
• Nearly a third of the respondents are cardiologists (CARDS)
Board Certification
100%
% of Physicians
80%
60%
50%
32%
40%
20%
11%
7%
0%
IM/FP
(n=218)
CARD
(n=138)
ENDO
(n=50)
Other
(n=30)
Base: Physicians (n=436)
Q3b Please describe your board certification: Cardiology, Endocrinology, Internal Medicine, Family Medicine, Other [specify]. Other includes Pediatrics, Lipidology/Clinical
Lipidology, Medical Biochem, and Nephrology.
16
Respondents by Lipid Practice Profile
• About 57% of the respondents either work in a lipid clinic or receive referrals
specifically for lipid management
% of Respondents
Lipid Practice Profile
100%
80%
57%
60%
43%
33%
40%
24%
20%
0%
Lipid Clinic
(n=155)
Lipid Specialist
(n=220)
Not Lipid Specialist
(n=282)
Base: All Respondents (n=657)
Q9 Which best describes the role lipid management (plays) in your practice [radio button]: (My practice is a) Lipid Clinic (i.e. staff and time specifically
dedicated to seeing patients for lipid disorders), lipid specialist practice (i.e. not a Lipid Clinic, but receive patient referrals from other clinicians for
patients specifically for lipid management), Lipid management is incorporated into my clinical practice, but I do not work at a Lipid Clinic, nor do I
receive referrals specifically for lipid problems (i.e. neither a nor b)
17
Lipid Practice Profile by Specialty
• Physician respondent, most lipid clinics/specialists are either IM/FPs or CARDs
Lipid Practice Profile by Specialty
100%
% of Physicians
13%
80%
60%
4%
8%
7%
15%
11%
19%
C
36%
C
44%
40%
AB
69%
20%
Other
ENDO
CARD
IM/FP
39%
34%
0%
Lipid Clinic A
(n=89)
Lipid Specialist B
(n=163)
Not Specialist C
(n=184)
Base: Physicians (n=436).
Q9 Which best describes the role lipid management (plays) in your practice [radio button]: (My practice is a) Lipid Clinic (i.e. staff and time specifically dedicated to seeing
patients for lipid disorders), lipid specialist practice (i.e. not a Lipid Clinic, but receive patient referrals from other clinicians for patients specifically for lipid management),
Lipid management is incorporated into my clinical practice, but I do not work at a Lipid Clinic, nor do I receive referrals specifically for lipid problems (i.e. neither a nor b)
18
Years in Practice by Profession
• Respondent physicians appear to be significantly older than respondent
NPs/PAs or pharmacists
– 41% of the respondent physicians had more than 26 years in practice
– Cardiologists skew older than other specialties
100
Years in Practice Distribution
Average Years in Practice
by Profession
100%
80
% of Respondents
Average # of Years
10%
60
40
22.4
BC
14.6
12.6
20
b
80%
BC
41%
41%
60%
PHYS
(n=439)
NP/PA
(n=102)
B
PHARM
C
(n=53)
A
A
40%
26+
21-25 years
10-20 years
5-9 years
40%
25%
28%
A
23%
A
0-4 years
20%
0%
A
6%
BC
17%
10%
0
17% b
8%
PHYS
(n=439)
15% A
13% a
7%
A
NP/PA
(n=102)
B
PHARM C
(n=53)
Base: Physician/NP/PA/Pharm (n=594)
Q2 How long you have been in clinical practice? [open # box] years [RANGE: 0-60]
19
Why Do Older Physicians Choose to
Practice Clinical Lipidology?
• Less invasive
• More cognitive
• Desire to treat pathophysiology rather than
symptoms of atherosclerosis
• Appreciation that it is the right thing to do
• Remembering that financial remuneration
was not the reason we entered medicine
Lipid Certification Status
• Overall awareness of the lipid certification program is high
– Two-thirds of respondents have either passed or are preparing for certification
– One-third of respondents are aware of but not pursuing an NLA certification
Lipid Certification Status
% of Respondents
100%
Passed /
Preparing 68%
80%
60%
41%
40%
27%
29%
20%
1%
1%
Not Asked
0%
Passed
Certification
Preparing for
Certification
Aware of/Not
Pursuing
Not Aware
(n=224)
(n=147)
(n=159)
(n=5)
(n=6)
Base: Physician/NP/PA (n=541). Physicians/NPs/PAs who self-identified as “Other” in Q1 were not asked Q4.
Q4 How would you characterize your status in terms of Certification for Clinical Lipidology (MD) or Clinical lipid specialist (PA/NP)? [select one] (I am/have) Passed the
Certification Program, Preparing to pass the Certification Program, Aware of, but not pursuing the Certification Program , or Not aware of the Certification Program
21
Certification Status by Lipid Practice Profile
• Not surprisingly, Lipid Clinic or Lipid Specialist HCPs are more likely to be
certified or plan to be certified
• About 40% of respondents who are non-lipid specialists/clinics are currently
preparing to be certified
Certification Status by Lipid Practice Profile
100%
% of Phys/NP/PA
21%
80%
52%
C
60%
aC
60%
40%
Passed
Certification
40%
AB
Aware of/Not
Pursuing Certification
17%
Not Aware
17%
20%
0%
28%
b
37%
21%
1% 1%
2% 2%
Lipid Clinic
(n=114)
A
Lipid Spec
(n=191)
Preparing for
Certification
aB
Not Asked
1% 1%
B
Not Lipid Spec C
(n=236)
Base: Physician/NP/PA (n=541). Physicians/NPs/PAs that self-identified as “other” in Q1 were not asked Q4.
Q4 How would you characterize your status in terms of Certification for Clinical Lipidology (MD) or Clinical lipid specialist (PA/NP)? [select one] (I am/have) Passed the
Certification Program, Preparing to pass the Certification Program, Aware of, but not pursuing the Certification Program , or Not aware of the Certification Program
22
Board Certification:
Limitation of Lipid Pulse Survey
• 41% of respondents stated that they are
board certified by the ABCL or ACCL
• As of November 2010, 691 or the active
2,461 active members (28%) were board
certified
• Thus, respondents likely represent a more
engaged group than the general membership
Type of Practice
• Nearly four-fifths of Physicians/NP/PA/Pharms work in either a single-specialty
or a multi-specialty group practice; the remainder are in solo practice.
Practice Type
% of Respondents
100%
80%
Group - 78%
60%
42%
36%
40%
22%
20%
0%
Solo A
(n=129)
Group - Single Specialty
(n=249)
B
Group - Multi-Specialty
C
(n=216)
Base: Physician/NP/PA/Pharm (n=594)
Q5 Please describe your clinical practice (select one): Is it a Solo, a Group – Single Specialty, or a Group – Multi-Specialty practice?
24
Practice Setting
• A majority (60%) of respondents are office-based
• More than one-fourth work in a hospital (outpatient clinics included)
• “Academic” indicates both hospital and clinic affiliation with an academic
institution
Practice Setting
(check all that apply)
% of Respondents
100%
80%
60%
60%
40%
25%
28%
20%
2%
7%
0%
1%
Residency
Other misc.
0%
Office-Based
(Private)
Academic
Hospital-based
Pharmacybased
Clinic*
Base: Physician/NP/PA/Pharm (n=594). Respondent may report more than on practice setting.
Q6 Which best describes your practice setting (select all that apply): a) Private practice
(office-based), Academic/research, Hospital-based , Pharmacy-based, Community clinic or Other setting ? [free text]
*Includes Community, HMO and Other
25
3. Staffing & Patient Volume
• FTEs
• Total Patient Volume
• Hours Per Week Seeing Patients
26
Total Clinician Staffing in Practice (FTEs)
• Reflecting presence in group practices, Lipid Clinics and Lipid Specialists
describe working with more staff
Average # of FTEs
Staffing in FTEs Distribution
100%
20
% of Respondents
Average # of FTEs
Lipid Clinic A (n=134)
15
11.7
c
12.0 c
9.2
10
5
Lipid Spec B (n=205)
80%
Not Lipid Spec C (n=255)
60%
40%
A
a
36%
33%
28%
15% 16%
20%
31%32%
27%
BC
23%
11% 12%
15%
7%
0
8% 6%
0%
Lipid Clinic
(n=134)
A
Lipid Spec
(n=205)
B
Not Lipid Spec
C
0-2.0
(n=255)
2.1-4.0
4.1-6.0
6.1-8.0
8.1 ore more
# of FTEs
Base: Physician/NP/PA/Pharm (n=594)
Q12 In terms of full-time equivalents (FTEs), including yourself, how many clinicians are in your practice?
27
Total Patient Volume
• Respondent clinicians who work in lipid clinics see a lower overall
volume of patients
– Possible reasons include academic research, clinical trial activities and
other responsibilities
Average # of Patients
2000
1,692
Patient Distribution
100%
Ac
1,430
a
1,082
1000
0
% of Respondents
Average # of Patients
3000
80%
0
1-99
100-499
500-1,999
2,000+
60%
BC
29% 28%
40%
20%
13%
Ac
C 39%
34%
aB
20%
25%
b
5%
a
33%
14%
11%
2%
26%
B 15%
7%
0%
Lipid
Clinic A
(n=134)
Lipid
Spec B
(n=205)
Not Lipid
Spec C
(n=255)
Lipid Clinic A
(n=134)
Lipid Spec B
(n=205)
Not Lipid Spec C
(n=255)
Base: Physician/NP/PA/Pharm (n=594)
Q8 How many patients are under your care in your personal practice? If NA enter zero. [# box – 5 digits (0-99999)]
28
Hours Per Week Seeing Patients
• Respondent clinicians who work more in lipid-focused settings spend less of
their time actually seeing patients for all types of medical issues
Hours Per Week
Distribution
100
100%
80
80%
% of Respondents
Average Hours Per Week
Average Hours Per Week
Seeing Patients
60
34.7
40
A
35.3
A
25.1
20
0
1-19
20-39
40+
A
60%
49%
BC
37% 38%
40%
55%
A
C
C
37%
28%
25%
20%
12%
2%
1%
ab 13%
4%
0%
0
Lipid Clinic
(n=134)
A
Lipid Spec
(n=205)
B
Not Lipid Spec
(n=255)
C
Lipid Clinic A
(n=134)
Lipid Spec B
(n=205)
Not Lipid Spec C
(n=255)
Base: Physician/NP/PA/Pharm (n=594)
Q10 Please indicate the number of hours per week you spend seeing patients. If NA enter zero: [# - 2 digits (0-99)]
29
4. Lipid Practice Characteristics
•
•
•
•
Practice Services
Lipid Management Staffing
Lipid Management Patient Volume
Time Respondents Spend Seeing Lipid
Management Patients
• Anticipated Changes in Lipid Practice
Characteristics
• Loss / Profitability
30
Frequency of Practice Services
• More than half of practices provide diabetes management, nutrition/exercise
programs, and weight management services.
% of Respondents
100%
80%
69%
60%
59%
60%
41%
40%
24%
10%
20%
6%
6%
5%
Other HTN/
Lipids
Diagnosis &
Mgt.*
Other Misc./
General
Health**
Other Cardio
Services***
1%
0%
Diabetes
management
Nutrition/
Exercise
programs
Weight
Clinical trial
Management participation
Cardiac
Rehab
LDL
Apheresis
Other
Teaching,
Educational
Services****
*Includes: Lipid management, Hypertension/Anticoagulation Management, CIMT, HTN management, Advanced lipid/lipoprotein testing
**Other miscellaneous mentions, Internal medicine, Lab, Sports medicine
***Non-Invasive Cardiology Diagnostics, General (e.g. Stress testing/(nuclear/echo), Cardiology services (general cardiology/non specific), Preventive
Cardiology Services & Risk Assessment ((non-specific)), Interventional Cardiology
****Smoking cessation, Diabetes education, Teaching/education (non-specific), Med management/education (non-specific)
Base: Physician/NP/PA/Pharm (n=594). Total is greater than 100% due to multiple responses.
Q15 Please indicate which of the following services your practice provides: [check boxes], Clinical trial participation, Cardiac rehab, Diabetes management, Nutrition/exercise
programs, Weight management, LDL apheresis, Other – please specify [fill in blank]
31
Frequency of Practice Services
• Lipid Clinics (to a lesser extent Lipid Specialists) are more likely to offer
nutrition/exercise programs, weight management and clinical trial participation
Services Provided by Lipid Practice Profile
Lipid Clinic A
Lipid Spec B
Not Lipid Spec C
(n=134)
(n=205)
(n=255)
100%
% of Respondents
BC
A
80%
A
71%73%
60%
60%
79%
BC
C
62%
48%
71% c
60%
52%
BC
63%
C
46%
40%
26%
C
34% C
30%
15%
20%
bC
19% C
12%
4%
Ab
7% 5% 6%
a
1% 4%
9%
6% 4% 6%
b
2% 1% 2%
0%
Diabetes
management
Nutrition/
Exercise
programs
Weight
Management
Clinical trial
participation
Cardiac
Rehab
LDL
Apheresis
Other HTN/
Lipids
Diagnosis &
Mgt.*
Other Misc./
General
Health**
Other Cardio
Services***
Other
Teaching,
Educational
Services****
Base: Physician/NP/PA/Pharm (n=594). Total is greater than 100% due to multiple responses.
Q15 Please indicate which of the following services your practice provides: [check boxes], Clinical trial participation, Cardiac rehab, Diabetes management, Nutrition/exercise
programs, Weight management, LDL apheresis, Other – please specify [fill in blank]
32
Frequency of Practice Services Offered:
Study Limitation
• Note that 10% of respondents reported that
LDL apheresis is offered in their practice
• This response is clearly not reflective of the
general membership of clinical lipidologists
Past Year and Anticipated Changes:
Patient Volume
• About 60% of LC/LSs respondents indicate that their patient volume has
increased in the past year
• Lipid clinic respondents are slightly more likely than lipid specialists to expect
increased patient volume in the next 3 years
Decrease
Over the past year my patient volume has…
% of Physicians
100%
80%
No Change
Increase
Not asked
Over the next 3 years, I expect patient volume to…
6%
9%
5%
7%
11%
24% A
33%
30%
60%
80%
40%
60%
60%
2%
1%
b
71%
20%
0%
Lipid Clinic
(n=114)
A
Lipid Spec
2%
B
(n=191)
Lipid Clinic
(n=114)
1%
A
Lipid Spec
B
(n=191)
Base: Physician/NP/PA who works in a Lipid Clinic or Lipid Specialist practice (Q9) (n=305)
Q20 Please describe the changes in your lipid management practice (in terms of Decrease(d) No(t) Change(d) Increase(d))
Over the past year my patient volume has… // Over the next 3 yrs, I expect patient volume to… // Over the next 3 years, I expect staffing needs to… // Over the next 3 years, I
expect equipment needs to… // Over the next 3 years, I expect payer (insurance/Medicare/Medicaid) reimbursement pressures to…
34
Loss/profitability
• Respondents who work in lipid clinics (only) were asked about the profitability of
their practices
– Approximately two-thirds of these respondents say they operate at break-even or
better
At break-even or better
by Lipid
Practice Profile
At a loss
by Specialty
by Profession
% of Physicians
100%
40%
80%
66%
64%
c
67%
75%
60%
58%
c
69%
72%
40%
ab
60%
20%
34%
36%
Lipid Clinic
PHYS
NP/PA
PHARM
(n=134)
(n=90)
(n=24)*
(n=20)*
33%
42%
31%
25%
28%
0%
A
B
C
FM/IM
(n=35)
A
B
CARD
ENDO
(n=32)
(n=10)*
C
OtherD
(n=12)*
Base: Physician/NP/PA/Pharm (for Profession and Lipid Practice Profile) who works in a Lipid Clinic (Q9) (n=134)
Base: Physician (Speciality) who works in a Lipid Clinic (Q9) (n=89)
Q21 From a financial standpoint, do you consider your lipid clinic to be operating (select one): [radio button] At break-even or better , At a loss.
*Note: Small base size. Interpret with caution
35
Loss/Profitability:
Limitations of Lipid Pulse Survey
• Survey only employed financial appraisal by
clinician
• No verification by administrator of CFO
• Likely result is an overestimation of
profitability of many of these programs
• Are endocrinologists really different?
5. Lipid Management Referral
Patterns
• Referral Patterns
• Referral Reasons
37
Lipid Management Referral Patterns
• Amongst LC/LSs referral sources are fairly similar across all specialty types
• Respondent IM/FPs do receive about 20% of their referrals from cardiologists
Lipid Management Referral Patterns by Specialty
IM/FP
CARD
ENDO
Other
Mean % Referred
From Specialist
100%
80%
63%
50%
d
71%
60%
aD
68%
D
15%
40%
8%aB
22% B
16%
20%
4%
11%
27%
3%
10%
0%
IM/FP
24%bD
A
(n=85)
CARD
(n=99)
4%
4%
B
ENDO
(n=34)
C
Other
D
(n=17)*
(n=269)
Base: Respondent is a Physician, NP or PA at Q1, Lipid clinic/specialist at Q9 and has patients referred for lipid management specifically at Q17
Q18 Of referrals you receive for lipid management, please describe the type of referring clinicians: [enter the % of referred patients] GP/FP or Internist, Cardiologist,
Endocrinologist, Other, please specify______ , Other, please specify______ [sum to 100%]
*Note: Small base size. Interpret with caution
38
Lipid Management Referral Reasons
• Respondent Lipid Clinics/Specialists receive patient referrals for similar reasons
– About half are due to elevated LDL-C, combined dyslipedmia
– Statin intolerance accounts for ~ 20%
– High TGs makes up just under 20% of referrals
Reasons for Lipid Management Referral by Lipid Practice Profile
Elevated
LDL-C
Hypertriglyceridemia
Isolated
low HDL
Combined
dyslipidemia
Statinintolerance
Presence of CVD
Other
or evidence of risk
with normal lipid profile
Mean % Referred
From Specialist
100%
22%
24%
18%
17%
7%
8%
40%
25%
24%
20%
20%
19%
80%
60%
0%
7%
1%
Lipid Clinic
(n=269)
6% 1%
A
Lipid Spec
B
(n=97)
(n=172)
Base: Respondent is a Physician, NP or PA at Q1, Lipid clinic/specialist at Q9 and has patients referred for lipid management specifically at Q17
Q19 Of those patients referred to you for lipid management, please indicate the reason for referral: Enter the % Patients seen for Elevated LDL-C, Hypertriglyceridemia, Isolated
low HDL, Combined dyslipidemia, Statin-intolerance, Presence of CVD or evidence of risk with normal lipid profile, Other, please specify______ , Other, please specify______ [sum
to 100%]
6. Beliefs & Information Sources
• Tests Routinely Ordered
• Parameters Most Predictive of
Cardiovascular Risk
• Education Needs
• Information Mediums / Sources
• New Product Awareness
40
Tests Routinely Ordered
Lipid Clinici
Lipid Specj
Not Lipid Speck
(n=114)
(n=191)
(n=236)
Triglycerides
93%
95%
95%
HDL-C
95%
95%
96%
LDL-C
91%
93%
92%
Non-HDL
68%
78% I
77% I
CRP
63%
62%
66%
Lp(a)
62% jK
54% K
42%
Apo B
52% k
51% k
42%
Lipoprotein particle size
41%
44%
42%
Lipoprotein particle #
38%
61% IK
42%
19% k
17% k
12%
18%
30% Ik
23%
Other apolipoproteins
14% K
10% k
6%
Genetic testing for FH
9% jK
4%
3%
Genetic markers, e.g., KIF6
7%
16% Ik
10%
None of the above
1%
1%
1%
Not asked
2%
1%
1%
APO E
Lp-PLA2
Base: All Respondents (n=657)
Q22-1.
Of the lipid parameters and related topics listed below: What tests do you order routinely (more than once a month in your overall practice)? (check all that apply)
41
Recommendations for General Approaches to Risk
Stratification
Global risk scores (such as the Framingham Risk
Score [FRS]) that use multiple traditional
cardiovascular risk factors should be obtained for
risk assessment in all asymptomatic adults without
Benefit>>>Risk
Should be performed a clinical history of CHD. These scores are useful
Limited populations
for combining individual risk factor measurements
into a single quantitative estimate of risk that can
be used to target preventive interventions.
I IIa IIb III
>90% order lipid profile
Lipid profile enables global risk scoring
2010 ACCF/AHA Guideline for Assessment of
Cardiovascular Risk in Asymptomatic Adults
Recommendations for Measurement of C-Reactive Protein (CRP)
In men 50 years of age or older or women 60 years
of age or older with LDL cholesterol less than 130
mg/dL; not on lipid-lowering, hormone
I IIa IIb III
replacement, or immunosuppressant therapy;
without clinical CHD, diabetes, chronic kidney
disease, severe inflammatory conditions, or
Benefit>>Risk
contraindications to statins, measurement of CRP
Is reasonable
Limited populations
can be useful in the selection of patients for statin
therapy.
>60% order hs-CRP
2010 ACCF/AHA Guideline for Assessment of
Cardiovascular Risk in Asymptomatic Adults
Recommendation for Lipoprotein-associated Phospholipase A2
I IIa IIb III
Lipoprotein-associated phospholipase A2 (LpPLA2) might be reasonable for cardiovascular risk
assessment in intermediate-risk asymptomatic
adults.
Benefit ≥ risk
May/might be considered
Limited populations
18-30% order Lp-PLA2
2010 ACCF/AHA Guideline for Assessment of
Cardiovascular Risk in Asymptomatic Adults
Recommendation for Lipoprotein and Apolipoprotein
Assessments
I IIa IIb III
Not recommended
Measurement of lipid parameters, including
lipoproteins, apolipoproteins, particle size, and
density, beyond a standard fasting lipid profile is not
recommended for cardiovascular risk assessment
in asymptomatic adults.
56-61% order apo B
38-61% order LDL-P
18-28% order particle size
29-35% order Lp(a)
2010 ACCF/AHA Guideline for Assessment of
Cardiovascular Risk in Asymptomatic Adults
Parameters Most Predictive of CV Risk
Lipid Clinici
Lipid Specj
Not Lipid Speck
(n=114)
(n=191)
(n=236)
HDL-C
63% j
55%
58%
CRP
47% K
41%
36%
Non-HDL
61%
59%
57%
Apo B
61%
60%
56%
LDL-C
55%
48%
56% j
Lipoprotein particle #
50%
56% k
50%
Lp(a)
35%
32%
29%
Lipoprotein particle size
23%
18%
28% J
Triglycerides
19%
25%
29% I
Lp-PLA2
16%
22% I
18%
Genetic markers, e.g., KIF6
7%
6%
6%
Genetic testing for FH
4%
2%
5% j
APO E
3%
6% ik
3%
Other apolipoproteins
3%
3%
2%
None of the above
1% j
0%
1% j
Base: All Respondents (n=657)
Q22-2.
Of those listed, which 5 parameters you believe to be most predictive for assessing CV risk? (select 5)
46
Greatest Need for Education/Awareness
Statin intolerance: evaluation and management
Strategies for improving patient compliance with therapy
(medication and/or diet/lifestyle)
Metabolic syndrome
Genetic testing for FH
Lipoprotein particle #
Non-HDL
Apo B
Genetic markers, e.g., KIF6
Lp-PLA2
Familial hypercholesterolemeia screening and diagnosis
Lipoprotein particle size
Lipid clinic practice management
Lp(a)
HDL-C
CRP
Triglycerides
Other apolipoproteins
APO E
LDL-C
None of the above
Lipid Clinici
Lipid Specj
Not Lipid Speck
(n=155)
(n=200)
(n=282)
JK
39%
36%
52% Jk
37%
43% j
45% jk
21% j
34%
30%
30%
27%
24%
23%
19%
17%
15%
14%
12%
11%
8%
6%
3%
1%
37%
13%
41% ik
26%
36% ik
30%
33% I
18%
16%
15%
21% I
19% I
16%
18% ik
8%
10% I
6%
1%
35%
18% j
33%
26%
30%
25%
31% I
22%
23% J
24% iJ
21% I
17%
14%
12%
9%
13% I
10% Ij
1%
57%
Base: All Respondents (n=657)
Q22-3.
Of those listed, the 5 topics where you believe there is greatest need for increased awareness and/or education? (select 5)
47
Sources Used to Learn About Lipid Management
• Respondents cite JCL, NEJM and JACC as most often used sources for LM information
• ~60% describe reading journals online; 45% use other (non-journal) online source
Journal of Clinical
Lipidology/Journal
of Lipidology
NEJM
Lipid Spin
JACC
Circulation
JAMA
% of Respondents
100%
45%
23%
20%
20%
16%
10%
88%
NLA
AHA
ACC
63%
21%
19%
88%
NLA
NEJM
Heart.org
Medscape
23%
13%
12%
12%
80%
62%
Heart.org
Medscape
NLA
UpToDate
17%
13%
12%
11%
60%
45%
40%
NLA
27%
ReachMD 12%
Heart.org 10%
27%
20%
NLA
42%
Heart.org 9%
5%
1%
0%
Reading journals
(printed versions)
Attending
conferences
Reading journal
websites or email
updates
Reading other onListening to or
Reading or
line sources (not watching Pod-casts participating in onjournals)
or other audio/video line chat rooms
lectures on-line
with peer clinicians
None of the above
Base: All respondents (n=657). Total is greater than 100% due to multiple responses. Top mentions noted in text boxes.
Q23. Which sources do you use to learn about lipid management? Which ones?
48
Awareness of Technologies/Therapies in
Development
% of Total
CETP inhibitors/blockers
Genetic testing/screening
LDL Apheresis/apheresis/DALI LDL apheresis
Mipomersen
New drugs (to replace statins)/new statins
LpPLA2
HDL therapy/drugs/formulations/in development (unspecified)
apoB antisense/inhibitors
Meds/therapy to raise HDL
apo A1 infusion/mimetics infusion
KIF6
HDL Mimetics
Antisense oligonucleotides/antisense therapy
MTP inhibitors
Particle #/HDL particle #/lipoprotein particle #/lipid particle #
Gene therapy
RNA1/antisense RNA
Low flush/no flush niacin/niacin combo
CIMT
HDL infusion therapy
11.1% (n=73)
4.7% (n=31)
4.6% (n=30)
4.3% (n=28)
2.7% (n=18)
2.7% (n=18)
2.4% (n=16)
2.3% (n=15)
1.8% (n=12)
1.8% (n=12)
1.8% (n=12)
1.5% (n=10)
1.5% (n=10)
1.5% (n=10)
1.4% (n=9)
1.2% (n=8)
1.2% (n=8)
1.2% (n=8)
1.1% (n=7)
1.1% (n=7)
Base: All Respondents (n=657)
Q26. What - if any - new therapies or technologies in development for lipid management are you aware of? Open-end - Top mentions shown.
49
Summary of Tests Ordered and
Information Sources/ Needs
• Lipid Tests Routinely Ordered
– Over 90% routinely order the standard lipid panel (e.g., HDL, LDL, TG)
– About half of the MD respondents reported regularly (>once/month) ordering particle
#, Lp(a), Apo B (Two-thirds said CRP) in addition to the standard lipid panel
– Lp(a) and Apo B were found to be more common in more lipid-centric physicians
• Lipid Parameters Most Predictive of CV Risk
– Non-HDL/Apo B believed to be the same in terms of being most predictive of risk
• However, Apo B is ordered less often, this is likely because clinicians can obtain non-HDL for
free of cost w/ standard panel
– Followed by HDL, then lipoprotein particle #
• Interestingly, lipid clinic physicians frequently indicated that genetic testing for FH was one of
the top five parameters to measure CV Risk
• Greatest Need for Education/Awareness
– Statin intolerance / patient compliance were frequently mentioned
• These are related and appear more frequently in lipid clinic responses compared to other
clinicians
– Lipoprotein particle # is also a top interest
7. NLA Membership
•
•
•
•
Membership Benefits
Membership Continuation
Promotion to Colleagues
NLA Suggestions
51
NLA Membership Summary
• Respondents indicate that education, certification & The
Journal of Clinical Lipidology subscription are most valued
• Over 95% of respondents intend to continue their NLA
Membership & would promote it to colleagues
• About half of survey respondents offer suggestions for
additional services
– A majority of these respondents suggest enhancing educational programs,
conferences, and using a web-based medium to increase participation
NLA Membership Benefits
• Respondent physicians and NP/PAs utilize the Journal of Clinical Lipidology
subscription more than pharmacists.
• Respondent NP/PAs and pharmacists value the certification opportunities more
than physicians and others.
• Respondent pharmacists value social networking/access to thought leads more
than physicians and NP/PAs
by Profession
(n=439)
A
NP/PA
B
PHARM
(n=102)
C
(n=53)
Other
D
(n=63)
c
100%
% of Respondents
PHYS
93%
89%
87%89%
c
80%
68%71%
Ad Ad
43%
B
40%
AB
41%
b
32%
25%
29%
BD
20%
67%
59%
54%59%
60%
23%25%
16%
d
15%
7%
11%
c
A
20%18%
7%
5%
A
18%
11%14%
0%
Advocacy
Colleagues
Education
opportunities
Certification
opportunities
Social Networking /
Access to Thought
Leaders
Journal of Clinical
Lipidology
subscription
Member discount
for educational
opportunities
Base: All Respondents (n=657)
Q27 What benefits of NLA membership do you value most? (select up to three) Responses accounting for less than 1% (Lipid Spin, other, and none) are not shown.
53
NLA Membership Continuation
• The vast majority of respondents plan to continue their membership.
• A very small minority plan to not renew for cost/expense or other
reasons (open-ends).
by Profession
98%
C
% of Respondents
100%
97%
97%
94%
80%
60%
40%
20%
0%
PHYS
A
(n=439)
NP/PA
(n=102)
B
PHARM
(n=53)
C
Other
D
(n=63)
Base: All Respondents (n=657)
Q28 Do you plan to continue your membership in the NLA? (Yes/No)
54
NLA Promotion to Colleagues
• Virtually all respondents would encourage their colleagues to join the NLA.
– The few exceptions cite reasons including colleagues’ lack of expressed interest
by Profession
% of Respondents
100%
98%
d
98%
d
98%
94%
80%
60%
40%
20%
0%
PHYS
A
(n=439)
NP/PA
(n=102)
B
PHARM
(n=53)
C
Other
D
(n=63)
Base: All Respondents (n=657)
Q29 Would you encourage colleagues to join the NLA? (Yes/No)
55
Suggested NLA services
• Only about half of survey respondents offer suggestions for additional services
• A majority of these respondents suggest enhancing educational programs, conferences, and
using a web-based medium to enhance participation in the organization
• The top suggestions for NLA are providing more services around education/learning and
conferences/meetings
Education/learning
Conferences/meetings
Web-based
Conference content
Miscellaneous
Awareness
Communication
Cost
Recognition as specialty
Participation
Interaction
Membership
Nothing/doing great job/fine as is
Don't know
No answer
PHYSA
NP/PAB
PHARMC
OtherD
(n=439)
(n=102)
(n=53)
(n=63)
17%
10% c
7%
6% c
6%
6% B
3%
2%
3% bc
1%
2%
1%
33%
6%
3% d
16%
8%
9%
7% c
3%
0%
1%
7% Ac
0%
4% ad
2%
1%
35%
13%AcD
1%
15%
4%
13% a
0%
2%
2% b
8% aBd
2%
0%
4% ad
4%
2%
45% a
6%
2%
11%
6%
10%
11% aC
6%
8% Bc
2%
5% a
2%
0%
2%
3% a
41%
3%
0%
Base: All Respondents (n=657)
Q30 What else could the NLA provide its members that it does not currently provide? (open-end) Nets are shown.
56
Summary
• Survey provided valuable, meaningful data to characterize clinicians
that focus on lipid management (NLA members)
• In general, greater differences in respondents were
observed by degree of lipid practice profile (e.g., lipid clinic vs. lipid
management vs. neither) than by specialty
• Respondents that identify themselves as working in a lipid clinic or
specialists are differentiated in terms of clinical environment and patient
offerings
In terms of practice environment, these specialists:
– Appear more likely to work in multi-specialty or group practices
– Lipid clinic respondents in particular were more likely to have an academic
affiliation
Summary
• Lipid Clinic (LC)/Lipid Specialist (LS) Practice Characteristics
– LC/LSs report slightly lower patient volume overall and spend fewer hours/week
with in partient care (potentially reflecting academic setting and related
activities)
– LC/LSs tend to spend more time with their patients, especially on initial visits
– LC/LSs are more likely to offer comprehensive services beyond purely medical
care to address cardiovascular risk with services such as weight management,
nutrition/exercise counseling, clinical trial participation and cardiac rehabilitation
services
– Respondents in these categories appear to expect an acceleration in expected
demand for lipid management
Summary
• Lipid Tests Routinely Ordered
– Over 90% routinely order the standard lipid panel (e.g., HDL, LDL, TG)
– About half of the MD respondents reported regularly (>once/month) ordering particle
#, Lp(a), Apo B in addition to the standard lipid panel; 2/3 said the same re; CRP
– Lp(a) and Apo B tests appear more frequently ordered by lipid specialists and lipid
clinic respondents than by those w/ out a more dedicated practice for lipid
management
• Lipid Parameters Most Predictive of CV Risk
– Non-HDL and Apo B are tied re: belief re: being the most predictive of risk
• However, Apo B is ordered less often, likely reflecting cost/availability
– Followed by HDL, then lipoprotein particle #
• Interestingly, lipid clinic physicians frequently indicated that genetic testing for FH
was one of the top five parameters to measure CV Risk
• Greatest Need for Education/Awareness
– Statin intolerance / patient compliance were frequently mentioned
• These are related and appear more frequently in lipid clinic responses compared to other
clinicians
– Lipoprotein particle # is also a top interest, as is Apo B