Q&A: Campaign aims to improve cholesterol screenings in primary care

Key takeaways:

• The program will reach over 30,000 clinicians and evaluate LDL screening education, awareness and management.
• An expert suggested “multifactorial barriers” are preventing routine follow-up with patients with high LDL.

The American College of Cardiology, or ACC, launched a quality improvement and education campaign directed at improving low-density lipoprotein screenings and treatment.

According to a press release, the campaign — Driving Urgency in LDL Screening — is estimated to reach around 30,000 primary care physicians and cardiologists and will evaluate gaps in LDL screening among patients with atherosclerotic CVD (ASCVD), along with structured education and awareness strategies among providers that may improve rates of LDL screenings, treatment, and control over 12 months.

The ACC noted that although its 2022 expert consensus decision pathway provided recommendations for clinicians on managing elevated LDL in patients unable to take statin therapy or who need further treatment, adherence to monitoring and management beyond initial screenings is “highly variable, leaving many patients undertreated and at continued risk.”

Ankeet S. Bhatt, MD, MBA, ScM, chair of the project steering committee for the Driving Urgency in LDL Screening program, spoke to Healio to discuss the suboptimal LDL screening rates, what the campaign’s strategies will involve and more.

Healio: Why have LDL screenings been lacking?

Bhatt: We know that heart disease is the number one killer of people worldwide — so, we're dealing with an important issue. The first step is to arm clinicians with the information to be able to mitigate risk for ASCVD. We know one of the strongest — if not the strongest — risk factors is the amount of [LDL cholesterol (LDL-C)] that a patient has, and how high it remains over time.

Routine, guideline-supported screening has been lacking for a number of reasons. We're seeing the similar implementation challenges across cardiometabolic disease, including heart failure, chronic kidney disease and others. There are a number of inertial barriers, at the patient level, provider level and system levels that make it challenging to have routine follow-up around things like LDL-C. These barriers limit our ability to mitigate risk and durably lower LDL-C. I think there are a lot of challenges that we're hoping that this program starts to uncover and address.

Healio: Can you go a bit into detail on some of the campaign’s strategies?

Bhatt: We're really excited about this program because we think it provides the necessary foundational work to understand optimal implementation strategies to improve screening in at-risk patients with CVD. There are a few different things that we're really interested in evaluating using the novel network. We're going to be able to understand whether messages delivered at the point-of-care to providers caring for these patients might be tailored in a way that we can support further screening. What excites me is that we’ll hopefully have the ability to look at number of process and engagement metrics, which are fundamental to understanding the reach, adoption and effectiveness of an implementation science intervention. We're going to be able to look at, for example, engagement with these digital tools and messages. We'll also have the ability to assess how clinicians engage with a clinical dashboard designed to give physicians all the information they need to understand screening and treatment gaps to durably lower LDL. We're going to be able to see how physicians and other providers engage with these systems at a very granular, process metric level.

In addition, we hope to understand implementation outcomes, such as the percentage of patients who get appropriate screening for LDL-C or get a repeat test after they've had a major change in their therapy.

Finally, we’re going to be able to look at the potential downstream effects of these kinds of interventions — particularly around the control of LDL-C and the prescription of medicines that we know to be beneficial in lowering risk, such as high-intensity statin therapy and others.

Healio: What are the implications for PCPs?

Bhatt: Primary care is the bedrock of where screening and evaluation of ASCVD happens, and we couldn’t be more excited about the primary care reach of this program. Our team includes primary care providers to help shape, design and execute the program. We think that's a critical portion of this because preventing CVD and lowering LDL often begins well before patients ever see a cardiologist or another specialist. The bulk of this most important work happens within the primary care sphere.

We're hoping to be able to contribute meaningfully to understanding which strategies might augment PCPs ability to screen and treatment most efficiently, boosting their ability to provide care without creating further sludge in their workflows.

What we'd like is to add to the evidence about how we can do this in a manner that doesn't create undue burden on physicians but facilitates them to be able to screen and respond to patients with LDL-C. Primary care is our natural partner in this work, and how we learn and work with them will be part of the fun of this study. We also will have PCPs included on our leadership team.

Reference:

• ACC launches new quality improvement and education program to increase cholesterol screenings. https://www.acc.org/Latest-in-Cardiology/Articles/2023/09/12/13/25/ACC-Launches-New-Quality-Improvement-and-Education-Program-to-Increase-Cholesterol-Screenings. Published Sept. 12, 2023. Accessed Sept. 28, 2023.