Abstract Background Cardiovascular disease remains a leading cause of morbidity and mortality globally. While lipid management is one of the most effective approaches for reducing CVD burden, optimally managing cholesterol among high-risk patients with atherosclerotic cardiovascular disease (ASCVD) remains a daunting task for healthcare systems world-wide. Purpose To evaluate lipid lowering therapy (LLT) use and adherence, and LDL-C levels at baseline and 18-months among United States (US) Veterans Health Administration users participating in the Veterans Affairs Lipid Optimization Reimagined Quality Improvement (VALOR-QI) Program. Methods VALOR-QI is a quality improvement (QI) collaboration between the US Department of Veterans Affairs (VA) and the American Heart Association (AHA) with the goal of improving lipid management among Veterans with ASCVD. Clinical Champions, Health Care Coaches, and participating providers from 50 VA sites work with AHA QI Consultants to address site-level barriers to achieving optimal lipid levels. Veterans were considered engaged if they had an ASCVD diagnosis at two outpatient or one inpatient visit or one ASCVD procedure, and a qualifying appointment with a participating provider during the program. Baseline was defined as the date of their LDL-C lab closest to their first visit with priority given to labs within 365 days before their first visit and 18-month follow up was defined as the date of the LDL-C lab closest to 18 months after entering the program. Among Veterans who were in the program ≥18 months, had 1 LDL-C measure, and who were not at LDL-C goal at baseline, we investigated LLT use, LLT adherence, percent meeting an LDL-C goal of 70 mg/dL and mean LDL-C change (paired t-test) at baseline and 18-month follow-up. LLT adherence was defined using medication possession ratio (MPR) =0.8, calculated as the sum of days’ supply for all fills of a given LLT during the time period divided by the number of days in the time period. Results Among 3,110 Veterans engaged in the program ≥18 months with at least two lipid labs mean (SD) age 68.8 (10.0) years, 95% men, 68% white race, LLT use increased from 75% to 82% and LLT adherence increased from 62% to 76% from baseline to 18 months after. The proportion who met the LDL-C goal 70 mg/dL increased by 28%. We observed a mean change in LDL-C of -13.2 mg/dL (SD: 35.0). Conclusion A quality improvement program designed to address barriers to achieving optimal lipid levels can increase LLT use and adherence, and improve LDL-C values over 18-months among Veterans Health Administration users with ASCVD.Table
Ward et al. (Sat,) studied this question.