Abstract 14485: Landscape of Lipid Management Following an Acute Coronary Syndrome: Survey of Canadian Specialists
Bibliographic record
Abstract
Background: Following an acute coronary syndrome (ACS), patients are at high risk for subsequent cardiovascular events. LDL-cholesterol lowering remains a pillar in secondary prevention following ACS. There remains significant variability in the application of LDL-lowering therapies in clinical practice. Methods/Results: A cross-sectional, online survey of 200 cardiovascular specialists across Canada. The survey consisted of 50 multiple-choice questions and free text entry. The survey was distributed to members of the Canadian Collaborative Research Network with $125 stipend offered. All participants stated that it was standard of practice to obtain a lipid panel during ACS admission, often within the first 24 hours (67.5%, n=135). 68.5% (n=137) stated their hospitals had standing orders for statin initiation at ACS presentation. In very high-risk patients (multiple cardiovascular events, polyvascular disease), the majority (75.5%; n=151) of participants indicated a target LDL-c of <70 mg/dL. Further, 22% (n=44) would target lower LDL-c levels ranging from 19.3-65.7 mg/dL. Only 32.0% (n=64) of participants stated that >70% of their ACS patients were at/below LDL-c targets of <70 mg/dL. Patients presenting with ACS despite high intensity statin with LDL-c above target were most often (80.0%; n=160) started on ezetimibe. Post-discharge, the majority of respondents indicated they would assess the patient in clinic at 1-3 months, and <50% would order a lipid profile prior to that visit. Respondents underestimated the prevalence of familial hypercholesterolemia (FH) in both the general population and in ACS patients. Experience with PCSK9 inhibitors varied with 42.0% (n=84) having prescribed to less than five patients. Forty percent of respondents expressed safety concern at achieved LDL-e levels below 40 mg/dL. Conclusion: There is significant variation in practice patterns involving LDL-lowering therapies in the post-ACS period, and probable under-recognition of FH in this very-high risk population. Further evidence to inform guidelines and clinical practice is urgently required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".