Methods
The Guidelines Oriented Approach to Lipid lowering (GOAL) Canada(11) was an interventional program supported by Amgen Canada. It was an investigator-initiated study started in 2015 and coordinated by the Canadian Heart Research Centre, an academic research and education physician organization. The intervention studied was physician education/lipid management reminders applied at the end of each of three visits based on data entry in the electronic case report form (eCRF). Participating physicians received fair market value compensation for completing the electronic case report form. The study was approved by central and institutional research ethics boards where appropriate and all enrolled patients provided informed consent.
Invitations to participate were sent to 750 Canadian physicians across Canada from a proprietary (CASL Regulation) Canadian Heart Research Centre list of physicians who participated in prior cholesterol-oriented data collection studies (12,13) and 248 were activated to enrol their patients for whom the participating physicians had the primary role for cholesterol lowering management. These physicians were asked to consecutively enrol at least 12 of their patients with either (1) clinical vascular disease such as coronary artery disease (CAD), cerebrovascular disease, abdominal aortic aneurysm, or peripheral arterial disease; or, (2) familial hypercholesterolemia (FH), as defined in the Canadian guidelines. (2). In addition, all patients had to have an LDL-C > 2.0 mmol/L despite maximally tolerated statin therapy (defined as having tried at least two statins, each at least on two reduced doses) for at least three months prior to enrolment. Patient outcomes for lipid lowering were assessed at baseline and twice more approximately 4-6 months apart. Physicians were asked to provide a single most important reason for each patient as to why the guidelines were not followed.