Abstract Body (Do not enter title and authors here): Background:
Current AHA/ACC guidelines recommend high-intensity statin (HIS) therapy plus adjuvant therapies including ezetimibe and PCSK-9 inhibitors for the secondary prevention of major adverse cardiac events (MACE) with a goal low-density lipoprotein cholesterol (LDL-C) level <70 mg/dL. ESC guidelines recommend a goal LDL-C <55 mg/dL for this population. Attention to guideline-recommended 12-week LDL-C levels in high-risk patients provides an opportunity to escalate lipid-lowering therapies (LLT) in high-risk patients to achieve an LDL <55 mg/dL. Here, we describe a multidisciplinary virtual care protocol for the escalation of LLTs in the outpatient setting at an urban safety net hospital.
Methods:
All patients ≥ 18 years of age who underwent a Left Heart Catheterization (LHC) for Acute Coronary Syndrome (STEMI, NSTEMI and Unstable Angina) were referred to a virtual lipid clinic at discharge. The virtual lipid clinic was staffed by a cardiology PharmD, and patients completed virtual visits at 6, 12, 24 and 36 weeks after discharge. Medication adherence was also evaluated by the PharmD during these visits. LLT with HIS were escalated to include ezetimibe, PCSK9i, and bempedoic acid as appropriate until LDL-C <55 mg/dL.
Results:
Between June 1, 2024 and April 7, 2025 196 patients underwent LHC for ACS and were subsequently referred to the virtual lipid clinic. A total of 68 patients were excluded. Of the remaining 128 patients, 50 patients (39%) met LDL-C goal and were discharged from the program. Of the 50 patients who met goal, 19 (88%) achieved LDL-C goal with HIS +/- ezetimibe, only 5 required evolocumab and 1 required bempedoic acid. A total of 39 patients (30%) were either lost to follow-up or transferred care to another facility, and 38 patients (30%) remain enrolled in our protocol.
Discussion:
In a safety-net system serving the urban poor, a virtual care model effectively improved LDL-C in high-risk patients with nearly half of 128 enrolled patients achieving LDL-C ≤55 - most within 12 weeks. Notably 88% reached this goal using only stantins and ezetimibe, highlighting the value of adherence education in delivering cost-effective care. Our experience supports using RNs, PharmDs, and titration protocols to provide high-quality care for underserved populations.