CLINICIANS’ SELF-REPORTED EFFICACY IN CARDIOVASCULAR PREVENTION PRACTICE IN THE SOUTHEASTERN UNITED STATES

Abstract

Therapeutic Area: Preventive Cardiology Best Practices Background: Cardiovascular disease disproportionately affects the Southeastern US. Cardiovascular preventive care is offered by various specialties with differences in training and perspectives. Therefore, there is potential heterogeneity in self-efficacy when delivering cardiovascular preventive care. We assessed clinicians’ self-reported efficacy regarding cardiovascular prevention practice in the Southeast US. Methods: We emailed a 21-item questionnaire four times between November 10, 2021, and January 3, 2022, to 956 clinicians (physicians, nurse practitioners, physician assistants, and pharmacists) from internal medicine, family medicine, endocrinology, and cardiology specialties in the Southeast US. We assessed clinicians’ self-efficacy using Likert scales. Participants rated self-efficacy as completely confident, fairly confident, somewhat confident, slightly confident, and not confident. We combined completely confident and fairly confident responses together and compared categorical responses from primary care providers (PCPs) (internal and family medicine) with specialists (endocrinology and cardiology) using Chi-Square test. Results: 264 clinicians from 19 institutions completed the survey (median age 39 years, 55% women). Specialists comprised 46% (9% endocrinology, 91% cardiology) and PCPs 54% (62% internal medicine, 38% family medicine). PCPs expressed lower self-efficacy compared to specialists in interpreting and managing results of coronary artery calcium testing (24% vs. 69%), high-sensitivity C-reactive protein (20% vs. 46%), lipoprotein(a) (17% vs. 40%), familial hypercholesterolemia (45% vs 72%), and in prescribing ezetimibe (64% vs. 88%), proprotein convertase subtilisin/kexin type 9 inhibitors (18% vs. 70%), and icosapent ethyl (18% vs. 46%) (Figure). Conversely, PCPs expressed greater self-efficacy compared with specialists in prescribing metformin (96% vs. 64%), sodium-glucose cotransporter-2 inhibitors (82% vs. 59%), and glucagon-like peptide-1 receptor agonists (86% vs. 40%) (P-value for all comparisons ≤0.0001). Both PCPs and specialists expressed lower self-efficacy in prescribing bempedoic acid (10%, 18%, P = 0.11) and higher self-efficacy in prescribing aspirin for primary prevention (75% vs 86%, P = 0.07). Conclusion: Our results highlight the heterogeneity in clinicians’ self-reported efficacy in CVD prevention practice in the Southeast United States. Further research should explore effective strategies to enhance clinicians’ self-efficacy.