Improving lipid-lowering treatment and cardiovascular risk management in primary care: findings from an audit and feedback project

Introduction Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide. Low-density lipoprotein cholesterol (LDL-C) plays a central role in atherogenesis and cardiovascular events. In real-world primary care, many patients at high and very-high cardiovascular risk (HCVR) do not achieve recommended LDL-C targets. Objectives This study evaluated whether an audit and feedback (A&F) intervention could improve lipid management in HCVR patients managed in general practice. Methods We conducted a retrospective-prospective observational study involving general practitioners (GPs). GPs were classified as active, participating in A&F training and feedback sessions, or controls, contributing data only. Patient-level data were extracted from electronic medical records across three 18-month observation periods (T0, T1, and T2). Active GPs received tailored performance reports and educational sessions after T0 and T1. Main outcomes included completeness of clinical data recording, LDL-C target attainment (<70 mg/dL), lipid-lowering treatment patterns, and treatment adherence. Results Compared with baseline, active GPs showed significant improvements in the recording of LDL-C (+18.3%), HbA1c (+5.7%), body mass index (+17.1%), smoking status (+4.4%), and alcohol consumption (+14.4%). LDL-C target attainment increased from 6.1% at T0 to 14.5% at T2, exceeding the proportion observed in controls at T2 (8.7%). The use of lipid-lowering therapy among active GPs increased from 48.9% at T0 to 61.3% at T2, while high-intensity therapy increased from 9.1% to 17.6%. Treatment adherence improved over time, with a higher proportion of patients adherent to high-intensity therapy and a reduction in non-adherent low-intensity therapy. Conclusion An audit and feedback intervention supported by a multidisciplinary team improved data completeness and lipid management in high-risk patients in the primary care setting.