Resident physician Université de Montréal Montréal, Quebec, Canada
Background: Managing dyslipidemia remains a major challenge for clinicians, especially given its impact on cardiovascular outcomes. With the rapid emergence of new studies and therapies, treatment guidelines continue to evolve, creating discrepancies in clinical practice. Canadian Cardiovascular Society (CCS) guidelines promote a target-driven approach, while other guidelines such as those from the Patient Experience Evidence Research (PEER) group advocate for simplified management strategies. A cardiology-focused community of practice—including physicians, nurses, and pharmacists—sought to create evidence-based educational tools to support clinical teaching. Using a research-development model and the Delphi method, we identified key learning objectives, developed training materials and clinical scenarios and created a clinical decision-making tool for secondary prevention of dyslipidemia. This was validated with a panel of multidisciplinary experts from the province of Quebec. This project aimed to develop and validate a practical, evidence-based clinical guide to support the management of dyslipidemia in secondary prevention, tailored to contemporary Canadian practice and therapeutic options, in the context of Quebec’s single payer healthcare system.
METHODS AND RESULTS: We conducted a comprehensive literature review of recent guidelines and pivotal trials related to dyslipidemia management in secondary prevention. Based on this review, we created a clinical decision-making guide incorporating traditional and novel lipid-lowering agents. To assess its clinical relevance and usability, we engaged a multidisciplinary panel of Canadian experts in cardiology, internal medicine, and lipidology. The clinical guide itself was evaluated through two rounds of a modified Delphi process using representative clinical scenarios. Experts rated their level of agreement with proposed management approaches, and internal consistency was assessed using Cronbach’s alpha.
A total of 15 experts participated in both Delphi rounds. In the first round, the Cronbach’s alpha was 0.65, indicating low agreement and prompting refinement of the guide. Following revisions based on participant feedback, the second Delphi round demonstrated improved consensus with a Cronbach’s alpha of 0.82 ([0.656-0.931]; P-Value < 0.001), indicating good internal consistency and expert concordance. Expert comments highlighted improved clarity, practical applicability, and relevance to current therapeutic strategies, including PCSK9 inhibitors and icosapent ethyl.
Conclusion: We developed and validated a practical clinical guide for the management of dyslipidemia in secondary prevention, adapting the existing guidelines and incorporating contemporary treatment options. The guide achieved strong expert consensus following iterative revisions, supporting its potential utility in standardizing and optimizing lipid management in Canadian clinical practice. Future work will focus on implementation strategies and impact evaluation on clinical outcomes.
