Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Cardiovascular disease (CVD) is a leading cause of mortality in liver transplant recipients (LTRs). However, there is a lack of LT-specific CVD clinical practice guidance. We sought to obtain perspectives on CVD risk factor care in LTRs among a national sample of multidisciplinary practitioners.
*Methods: Participants were asked to review CVD guidance recommendations adapted from evidence-based CVD guideline documents for 6 CVD risk factors (lipids, blood pressure (BP), tobacco use, weight management, glucose control and renal function). Surveys were distributed using REDCap electronic data capture. Participants ranked the importance of the proposed CVD guidance using a Likert scale and assessed its accuracy in LTRs. If the proposed CVD guidance was rated as inaccurate, clinical reasoning for disagreement was obtained.
*Results: Among 130 practitioners, 81 (65%) responded (53% female, 97% academic practice, 98% physicians). Primary specialty areas were hepatology (51%), cardiology (17%), primary care (11%), endocrinology (6%), nephrology (5%), critical care (5%) and surgery (3%). Respondents agreed on the importance of tobacco cessation, especially medication use. All agreed that CVD risk factor screening is important in LTRs, but there was substantial disagreement about screening frequency. Respondents agreed that statins are appropriate for secondary prevention of CVD, but requested more data to support statin benefit for primary prevention of CVD in LTRs. Most respondents were unsure about BP goal targets in LTRs, but agreed on pharmacologic approaches to BP management and when to refer to a specialist. Respondents agreed that BMI should be used to screen for obesity, but indicated that normal BMI (18-24.9 kg/m2) may not be an appropriate goal in LTRs. Many replied that overweight BMI or %weight loss may be more acceptable targets. Finally, respondents agreed that diet, exercise, counseling, and weight loss programs are applicable and important in LTRs. However, they were not confident in their ability to recommend weight loss pharmacotherapies, type of diet, or bariatric surgery.
*Conclusions: Multidisciplinary practitioners agree about the importance of screening for CVD risk factors in LTRs, but opinions regarding the frequency, optimal targets and interventions needed for CVD prevention vary widely. These findings highlight the need for user-centered design to adapt CVD guidelines to LTRs to optimize care coordination by a multidisciplinary treatment team and improve CVD outcomes in this high-risk population.
To cite this abstract in AMA style:Kosirog M, Adamski L, Daud A, Finn D, Gregory D, Lloyd-Jones DM, Holl JL, VanWagner LB. Multidisciplinary Practitioner Perspectives on Cardiovascular Disease Guideline Interventions in Liver Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/multidisciplinary-practitioner-perspectives-on-cardiovascular-disease-guideline-interventions-in-liver-transplant-recipients/. Accessed November 17, 2019.
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