Evaluation of Clinical Practice Guideline

Evaluation of Clinical Practice Guideline

Clinical practice guidelines (CPG) aim to standardize decision-making and optimize the quality of care. CPG is based on comprehensive research and the principles of evidence-based practice (AAFP.org, n.d.). CPG contains metrics that should be achieved and easily measured. This paper discusses hyperlipidemia and evaluates clinical practice guidelines used in the management of hyperlipidemia. Our assignment writing help is at affordable prices to students of all academic levels and academic disciplines.

Healthcare Problem Identified

The healthcare problem of concern is hyperlipidemia. It is marked by elevated levels of lipids in the blood. Notably, total cholesterol levels are elevated beyond 200 mg/dl (Su et al., 2021). Also, low-density lipoproteins (LDL) are higher than 100 mg/dl, whereas high-density lipoproteins (HDL) are below 50 mg/dl (Su et al., 2021). On the other hand, triglyceride (TG) levels are usually more than 150 mg/dl (Su et al., 2021). However, it is worth noting that patients with elevated blood TG levels remain asymptomatic until they exceed 1000 mg/dl (Su et al., 2021).

Hill and Bordoni (2022) report that genetic factors are linked to primary hyperlipidemia (PH). Primary hyperlipidemia is common among teenagers and young adults and predisposes patients to cardiovascular complications (Hill & Bordoni, 2022). It can be broadly classified into six types. Firstly, Type I presents with high levels of TGs, chylomicrons, and cholesterol (Ballout & Remaley, 2021). In this context, TG levels exceed 1000 mg/dl (Ballout & Remaley, 2021). Type I PH is associated with a lower risk of atherosclerosis than other PH types (Ballout & Remaley, 2021). Secondly, type II PH presents elevated levels of LDL and cholesterol (Ballout & Remaley, 2021). Thirdly, type II b PH presents elevated levels of LDL, cholesterol, VLDL (very low-density lipoproteins), and TGs (Ballout & Remaley, 2021). Fourthly, type III PH is characterized by elevated levels of intermediate-density lipoproteins, cholesterol, and TGs (Ballout & Remaley, 2021). Notably, total cholesterol levels exceed 300 mg/dl, whereas TG levels exceed 400mg/dl (Ballout & Remaley, 2021). Also, type III PH is common in people with comorbidities such as diabetes mellitus, hypothyroidism, and obesity. Fifthly, type IV PH presents with elevated VLDL and TGs (Ballout & Remaley, 2021). Lastly, type V PH presents with high levels of VDL, cholesterol, chylomicrons, and TGs (Ballout & Remaley, 2021).

On the other hand, environmental factors have been linked to acquired hyperlipidemia (AH). AH is caused by an individual’s lifestyle, underlying conditions, and medications. Examples of medications that have been implicated include glucocorticoids, antiretroviral, amiodarone, and hormonal contraceptives (Su et al., 2021). Examples of lifestyle factors include limited exercise, smoking, obesity, binge drinking, and unhealthy dietary habits (Su et al., 2021). Underlying medical conditions that increase the likelihood of AH include diabetes mellitus (DM), hypothyroidism, polycystic ovary syndrome, and renal disease (Ballout & Remaley, 2021).

CDC.gov (2023) reports that about ninety-four million people aged 20 years and above in the USA have elevated cholesterol levels (more than 200 mg/dl). Also, about 28 percent of this population has cholesterol levels that exceed 240 mg/dl (CDC.gov, 2023). About 7 percent of teenagers and children have elevated cholesterol levels (CDC.gov, 2023). In addition, approximately forty-seven million people are taking lipid-lowering medications (CDC.gov, 2023). According to CDC.gov (2023), the prevalence of elevated cholesterol levels is highest in Mississippi, Arkansas, and Louisiana. Hill and Bordoni (2022) report that the prevalence of hyperlipidemia is higher among males than females in the USA. CDC.gov (2023) reports that the prevalence is higher among non-Hispanic Asians, non-Hispanic whites, and Hispanics compared to non-Hispanic blacks. Hyperlipidemia predisposes patients to conditions such as stroke and heart disease. CDC.gov (2023) reports that stroke ranks fifth among the leading causes of mortalities in the USA, whereas heart disease ranks first.

As stated earlier, hyperlipidemia presents with elevated levels of cholesterol or TGs. Furthermore, it is marked by increased VLDL production, low HDL levels, and elevated LDL (Su et al., 2021). Elevated VLDL production is driven by lifestyle factors, genetic factors, and underlying medical conditions (Su et al., 2021). HDL facilitates the transfer of peripheral cholesterol to the hepatic system for metabolisms, whereas LDL transports cholesterol from the hepatic system to peripheral sites (Su et al., 2021). Elevated cholesterol damages vascular endothelium, leading to macrophage engulfment, oxidative stress, and secretion of inflammatory mediators such as cytokines (Su et al., 2021). This is succeeded by the proliferation of vascular muscle and plaque formation (Su et al., 2021). Continued plaque formation narrows arterial wall diameter (Su et al., 2021). Plaque rupture increases the risk of cardiovascular disease (Su et al., 2021).

Poorly managed hyperlipidemia increases the risk of complications. Firstly, poorly managed disease increases the likelihood of coronary artery disease and cerebrovascular accidents (Hill & Bordoni, 2022). Secondly, it increases the risk of peripheral artery disease and hypertension (Hill & Bordoni, 2022). Thirdly, it increases the risk of aneurysms and death. Furthermore, it predisposes the patient to type II DM. Timely initiation of lipid-lowering medications reduces the risk of these complications. Common complications related to pharmacotherapy include rhabdomyolysis, arthralgia, myalgia, and myopathy (Hill & Bordoni, 2022).

Practice Guideline

The ACC/AHA lipid guideline is an example of a clinical practice guideline used to manage patients with hyperlipidemia. This guideline focuses on an individualized approach to managing hyperlipidemia and preventing cardiovascular disease (Reiter-Brennan et al., 2020). To begin with, it explores the non-pharmacological methods of managing hyperlipidemia. Notably, fresh fruits and enables, low-fat poultry, seafood, limited sugary foods, and whole grains should be consumed (Reiter-Brennan et al., 2020). The guideline recommends a personalized nutritional plan to meet the individual’s preferences and recommend daily requirements. Furthermore, the guideline advocates for regular physical activity. People should engage in at least three aerobic and high-intensity physical activities weekly (Reiter-Brennan et al., 2020).

Besides lifestyle modification, the guideline identifies pharmacotherapy use in managing and preventing hyperlipidemia. In this context, statin therapy is the mainstay approach for the management of hyperlipidemia (Reiter-Brennan et al., 2020). The choice of statin therapy is dependent on the target and intensity of management. For instance, high-intensity management aims to lower LDL levels by about 50 percent (Reiter-Brennan et al., 2020). Examples of drugs used in this phase include Atorvastatin 40 mg daily and Rosuvastatin 20 mg daily (Reiter-Brennan et al., 2020). Also, moderate intensity management aims to lower LDL levels by thirty to forty-nine percent (Reiter-Brennan et al., 2020). Furthermore, low-intensity management aims to lower LDL levels by less than thirty percent (Reiter-Brennan et al., 2020). Examples of medications used include Simvastatin 10 mg daily, Fluvastatin 20 mg daily, and Pravastatin 10 mg day (Reiter-Brennan et al., 2020). According to Reiter-Brennan et al. (2020), the other pharmacological approaches include ezetimibe and bile acid sequestrants.

Secondly, the practice guideline formulates an elaborate framework for the primary prevention of hyperlipidemia among patients across different lifespans. Severe hypercholesterolemia among adult patients warrants prompt initiation of high-intensity therapy with statins. In this context, severe hypercholesterolemia presents with LDL levels equal to or greater than 190 mg/dl (Grundy et al., 2019). Ezetimibe should be added if LDL levels exceed 190 mg/dl or if initial statin therapy fails to achieve a fifty percent reduction in LDL levels (Reiter-Brennan et al., 2020). PCSK9 inhibitors should be added if LDL levels exceed 220 mg/dl after statin and ezetimibe therapy (Reiter-Brennan et al., 2020). Furthermore, moderate-intensity therapy with statins should be initiated promptly among adults with diabetes mellitus. In this scenario, the aim is to lower LDL levels by at least fifty percent (Reiter-Brennan et al., 2020). However, prompt therapy should not be initiated among non-diabetic adults aged between forty and seventy-five years, and their LDL levels range from 70 to 189 mg/dl (Reiter-Brennan et al., 2020). Based on the guidelines, clinicians should engage the patient and discuss risks, identify potential risk factors, and calculate a ten-year risk for atherosclerotic cardiovascular disease. Statin therapy should be initiated for patients with a risk of more than twenty percent (Reiter-Brennan et al., 2020). Lifestyle modifications are preferred when the ten-year risk is below five percent (Reiter-Brennan et al., 2020).

Chronic renal disease (CRD) is a risk factor associated with AH. As such, adults with CRD should receive moderate-intensity management using statin (Reiter-Brennan et al., 2020). Ezetimibe can be added to offer adequate control (Reiter-Brennan et al., 2020). In addition, the clinician should consider moderate or high-intensity therapy for HIV-positive adults aged forty to seventy-five years, with LDL levels of 70 to 189 mg/dl and a ten-year risk of more than 5 percent (Grundy et al., 2019). Also, the guideline advocates for risk factor assessment among children and teenagers. Statin therapy should be initiated if this population has significantly elevated lipid levels (Reiter-Brennan et al., 2020).

Reiter-Brennan et al. (2020) report that the other high-risk groups that require primary prevention include preterm births, preeclampsia, premature menopause, and gestational diabetes. Statin therapy is associated with teratogenicity (Grundy et al., 2019). As such, it is contraindicated during pregnancy. This population should be educated on the relevance of lifestyle modification. Effective contraceptive methods should be used by sexually active women who use statin therapy (Reiter-Brennan et al., 2020). Statin therapy should be withdrawn at least one month before the planned pregnancy (Reiter-Brennan et al., 2020).

Thirdly, the practice guideline formulates an elaborate framework for the secondary prevention of hyperlipidemia. Secondary prevention is recommended for patients with a history of myocardial infarction, cerebrovascular accident, and unstable angina (Reiter-Brennan et al., 2020). The very high-risk group comprises individuals with multiple cases of cardiovascular events. The guidelines recommend the addition of ezetimibe if the maximal statin dose produces LDLS levels equal to or greater than 70 mg/dl (Reiter-Brennan et al., 2020). Also, a PCSK9 inhibitor should be added in maximum doses of statin and ezetimibe to produce LDL levels equal to or greater than 70 mg/dl (Reiter-Brennan et al., 2020). For patients who are not at very high risk, the aim is to reduce LDL levels by at least fifty percent (Reiter-Brennan et al., 2020). When managing this population, high-intensity therapy should be switched to moderate-intensity therapy if the patient doesn’t tolerate therapy.

Fourthly, the practice guideline identifies adverse effects associated with statin therapy. Clinicians should be actively involved in patient education. Patients should be informed about the anticipated adverse effects and how to manage them. Common statin-related adverse effects include elevated creatinine kinase and myalgia (Reiter-Brennan et al., 2020). The incidence of myalgia ranges from one percent to twenty percent.

The Clinical Practice Guideline and the Health Problems

The practice guideline addresses hyperlipidemia adequately. To begin with, it explores the non-pharmacological methods and pharmacotherapy used in the management of hyperlipidemia. This information guides clinicians’ decision-making process in the management and prevention of hyperlipidemia. As stated earlier, lifestyle modification entails consuming fresh fruits and vegetables, low-fat poultry, seafood, limited sugary foods, and whole grains (Reiter-Brennan et al., 2020). The guideline recommends a personalized nutritional plan to meet the individual’s preferences and recommend daily requirements. Furthermore, the guideline advocates for regular physical activity. People should engage in at least three aerobic and high-intensity physical activities weekly (Reiter-Brennan et al., 2020). According to the guidelines, statins are the mainstay pharmacotherapy used in the management of hyperlipidemia. Statins are initiated in three phases: high intensity, moderate intensity, and low intensity (Reiter-Brennan et al., 2020). Other pharmacotherapy options include ezetimibe, PCSK9 inhibitors, and bile acid sequestrants (Reiter-Brennan et al., 2020).

Secondly, the guideline identifies primary and secondary prevention in special populations. This information is relevant because it enables clinicians to make plausible clinical decisions. For instance, statin therapy is associated with teratogenicity and is contraindicated during pregnancy (Reiter-Brennan et al., 2020). Adults with CRD should receive moderate-intensity management using a statin. In addition, the clinician should consider moderate or high-intensity therapy for HIV-positive adults aged forty to seventy-five years, with LDL levels of 70 to 189 mg/dl and a ten-year risk of more than five percent (Reiter-Brennan et al., 2020).

Currency of Evidence

The practice guideline is based on current evidence. Reiter-Brennan et al. (2020) report that the guidelines are based on the 2019 ACC/AHA lipid guideline. Furthermore, the guideline is published by credible and reputable authorities: the American Heart Association and the American College of Cardiology. This article offers evidence from classes I, IIa, level A, and level B-R. The evidence is based on randomized controlled trials. As such, its benefits outweigh the potential risks. The evidence should be implemented in contemporary practice.

Impact of CPG on Healthcare Providers’ Actions

The practice guideline directs clinicians in the management and prevention of hyperlipidemia. As earlier stated, it identifies pharmacological and non-pharmacological approaches involved in the management of hyperlipidemia. Notably, it specifies the dietary approaches and physical activity that should be adopted. Furthermore, it identifies the specific drugs and dosages recommended for high-intensity, moderate-intensity, and low-intensity therapy. The practice guideline identifies special populations and recommends the type of drugs that should be used. Examples of these populations include severe hypercholesterolemia, patients with diabetes mellitus, children and teenagers, diverse ethnicities, chronic kidney disease, HIV, women, and patients with chronic inflammatory conditions (Reiter-Brennan et al., 2020).

Effectiveness of the CPG in Patient Management

The effectiveness of the practice guideline in managing hyperlipidemia can be evaluated by checking key metrics. To begin with, high-intensity therapy aims to lower LDL cholesterol levels by more than or equal to fifty percent (Reiter-Brennan et al., 2020). As such, baseline LDL levels should be measured before the initiation of therapy. Subsequent measurements after initiating treatment will indicate whether or not LDL levels have been lowered by fifty percent. Secondly, moderate-intensity therapy aims to lower LDL levels by thirty to forty-nine percent (Reiter-Brennan et al., 2020). Similarly, baseline values should be measured, followed by subsequent measurements after initiating therapy. Thirdly, low-intensity therapy aims to lower LDL reveals by less than thirty percent (Reiter-Brennan et al., 2020). The success of these interventions will be indicated by the achievement of the anticipated goal and improved patient outcomes.

Analysis

Revision of the Clinical Practice Guideline

The clinical practice guideline (CPG) does not need revision. Firstly, it provides high-quality evidence that offers the maximal patient benefit and minimizes risk for potential harm. For instance, the guideline indicates the contraindications of statin therapy, potential adverse effects, and the relevance of clinician-patient engagement to minimize the risk of adverse effects. Secondly, the guideline acknowledges a holistic care approach when selecting non-pharmacological approaches. In this scenario, patients are allowed to present their preferences, which should be incorporated into the care plan. Thirdly, the guideline evaluates the cost-benefit analysis of the recommended treatment approaches. According to the guidelines, PCSK9 inhibitors should only be added after maximum doses of statin and ezetimibe fail to produce the desirable outcome (Reiter-Brennan et al., 2020). Reiter-Brennan et al. (2020) note that the cost of PCSK9 inhibitors was lowered by more than $8000 from 2018 to 2019.

Changes in the Clinical Practice Guideline

If I were to modify the CPG, I would recommend lower doses for the Asian-American population. Firstly, Reiter-Brennan et al. (2020) report that this population has increased sensitivity to statin therapy. Also, members of this population are slow metabolizers of statins. This is evidenced by higher plasma concentrations of rosuvastatin among members of this population compared to whites.

Impact of US Demographics and Healthcare Reform on Clinical Practice Guideline

The guidelines reveal that ethnicity affects statin metabolism. An increase in the number of Asian Americans is suggestive of an increase in slow metabolizers of statins (Reiter-Brennan et al., 2020). As such, the guideline will be modified to specify the dosage of statins such as rosuvastatin that should be administered to patients from various ethnicities. Healthcare reforms that champion lowering the cost of lipid-lowering medication may alter the practice guidelines. For instance, PCSK9 inhibitors can be the first-line approach for patients who are hypersensitive to statins and ezetimibe.

Strategies to Facilitate the Adoption of New or Modified Clinical Practice Guidelines

Various strategies can be used to facilitate the adoption of a modified CPG into clinical practice. Firstly, public education and sensitization will enable clinicians to recognize the significance of changes and modifications (Pereira et al., 2022). This can be accomplished via seminars and educational meetings. The target population is healthcare facilities and medical training institutions. Secondly, all stakeholders should receive periodic reminders (Pereira et al., 2022). Thirdly, periodic auditing will ascertain whether or not the practice guideline has been embraced in clinical practice. Auditing and feedback will enable healthcare facilities to adopt the clinical practice guidelines.

Evaluation

To determine the effectiveness of a new CPG, I will work in concert with patients, clinicians, and other stakeholders in academia. Firstly, I will interview clinicians to determine the patient outcomes and safety associated with the new CPG. Improved patient outcomes and safety will demonstrate the effectiveness of the new CPG. Also, the interview will focus on clinicians’ levels of satisfaction with the new CPG. High satisfaction levels will indicate the success of the CPG. Secondly, I will interview patients and their families. The interview will focus on satisfaction levels, patient-centeredness, and healthcare costs associated with the new CPG. The success and effectiveness will be demonstrated by high patient satisfaction levels, acknowledgment of patient-centeredness, and lower healthcare costs after the implementation of the new CPG.

Learning Points

Statin therapy is the mainstay approach for managing hyperlipidemia, and it is initiated in three phases based on the patient. The three phases include high-intensity therapy, moderate intensity, and low-intensity therapy.

Ezetimibe, PCSK9 inhibitors, and bile acid sequestrants are the other approaches used for managing hyperlipidemia.

Management of hyperlipidemia is individualized. Examples of special populations include adults with chronic renal disease and HIV, children and teenagers, and women.

Common adverse effects associated with statin therapy include myalgia and elevated creatine kinase.

Conclusion

Hyperlipidemia increases the risk of complications such as cardiovascular complications. Healthcare providers should engage patients and their families when implanting CPG used to manage hyperlipidemia. Patient engagement promotes a patient-centered approach to the management of hyperlipidemia. The success of CPG is evidenced by increased patient safety and better outcomes.

 References

AAFP.org. (n.d.). Clinical Practice Guideline Manual. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/cpg-manual.html

Ballout, R. A., & Remaley, A. T. (2021). Pediatric dyslipidemias: lipoprotein metabolism disorders in children. In Biochemical and Molecular Basis of Pediatric Disease (pp. 965-1022). Academic Press. https://doi.org/10.1016/B978-0-12-817962-8.00002-0

CDC.gov. (2023). High Cholesterol Facts. https://www.cdc.gov/cholesterol/facts.htm

Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., De Ferranti, S., Faiella-Tommasino, J., Forman, D. E., Goldberg, R., Heidenreich, P. A., Hlatky, M. A., Jones, D. W., Lloyd-Jones, D., Lopez-Pajares, N., Ndumele, C. E., Orringer, C. E., Peralta, C. A., … Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. In Circulation (Vol. 139, Issue 25). https://doi.org/10.1161/CIR.0000000000000625

Hill, M. F., & Bordoni, B. (2022). Hyperlipidemia. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559182/

Pereira, V. C., Silva, S. N., Carvalho, V. K. S., Zanghelini, F., & Barreto, J. O. M. (2022). Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Health Research Policy and Systems, 20(1), 1–21. https://doi.org/10.1186/s12961-022-00815-4

Reiter-Brennan, C., Osei, A. D., Uddin, S. M. I., Orimoloye, O. A., Obisesan, O. H., Mirbolouk, M., Blaha, M. J., & Dzaye, O. (2020). ACC/AHA lipid guidelines: Personalized care to prevent cardiovascular disease. Cleveland Clinic Journal of Medicine, 87(4), 231–239. https://doi.org/10.3949/ccjm.87a.19078

Su, L., Mittal, R., Ramgobin, D., Jain, R., & Jain, R. (2021). Current Management Guidelines on Hyperlipidemia: The Silent Killer. Journal of Lipids, 2021, 1–5. https://doi.org/10.1155/2021/9883352

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

HEALTHCARE PROBLEM IDENTIFIED: Briefly describe the health problem you have identified. Include a discussion of morbidity, mortality, epidemiology, and pathophysiology related to this health problem.

PRACTICE GUIDELINE: Describe the clinical practice guideline used for this problem. Reflect on the questions included. Expand on your answer using support from the evidence.

Does the clinical practice guideline adequately address the health problem? Describe.
Is this practice guideline based on current evidence (within five years)? What is the strength of this evidence?
Does this clinical practice guideline adequately direct the healthcare provider in the management of a patient with this problem?
How effective is this clinical guideline in the management of patients with this healthcare problem? Think about how you would assess the effectiveness of patient management.
ANALYSIS: Think about the future healthcare needs of patients with this problem, changing demographics, and changes in healthcare policies. Address these questions.

Does this clinical practice guideline need revision(s)? Please explain your answer in detail.
If you were going to revise this clinical practice guideline, what would you change? What evidence would you use to base your changes on?
How might changes in US demographics and healthcare reform affect this clinical practice guideline?
What strategies would you use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice?
EVALUATION How would you determine the effectiveness of this revised clinical practice guideline in directing care for patients with the identified health problem? Outline the steps you might employ.

LEARNING POINTS (3-5 bullet points outlining key learning in this case.)

REFERENCES (APA formatting, current within past five years.)

Expectations

Due: Monday, 11:59 pm PT
Length: 8 pages minimum, 12 pages maximum, not including the title page, abstract, and reference pages
Format: APA formatted paper – you can opt to use the prompts or a version of the prompt for headers, but do not copy the prompts directly into your paper
Research: APA formatting, current within past five years.