Abstract Body (Do not enter title and authors here): Background: Despite existence of effective drugs for treatment of dyslipidemia, only about one-third of Veterans at risk of ASCVD have optimal LDL-cholesterol (LDL-C).
Goals: The goal of this VALOR-QI program is to identify and address barriers to optimal LDL-C management among Veterans with prevalent ASCVD.
Approach: VALOR-QI program is a collaboration between the Department of Veterans Affairs (VA) and AHA with a total of 50 VA sites. Each site is headed by a clinical champion who leads a team of healthcare providers (n=843) and healthcare coaches (n=157) that work with AHA consultants to identify and address site-specific barriers to optimal lipid management. Eligible Veterans were those with prevalent ASCVD, LDL-C ≥ 70 mg/dL at baseline, and qualifying appointment with a participating provider during the program. Program success is monitored by prevalence of the use of lipid lowering therapy (LLT), percentage of Veterans with LDL-C <70 mg/dL, and change in mean LDL-C and adherence to LLT.
Results: This program involved 140,620 Veterans with ASCVD and LDL-C labs from 12/2022 through 6/2025. Overall, 78,749 Veterans had ASCVD and LDL-C ≥ 70 mg/dL at baseline (mean age 70±10 y, 7% women, and 69% White), and of these, 11,829 had a second LDL-C lab and had been in the program for 2 y (including 3,844 Veterans aged 75+y). Major barriers identified included staffing shortages, poor adherence to LLT, clinical inertia, and lack of patient and professional education on lipid management and lifestyle modification. Those barriers were addressed using a multiprong approach inclusive of the use of healthcare coach, engaging multidisciplinary teams, engagement list to identify at-risk Veterans, workflows for LLT escalation, educational materials on lipid/lifestyle management. Between baseline and June 2025, there was a 15.9 mg/dL reduction in mean LDL-C [from 104 ±31 to 88±36 mg/dL] with greatest reduction in Veterans with highest baseline LDL-C; adherence to LLT increased from 65% to 77% while LLT use improved from 78% to 88%; and prevalence of Veterans with LDL-C <70 mg/dL increased by 34% (from 0% to 34%) among Veterans who were in the program for 2 years. Among Veterans aged 75+ y at baseline, there was a 36% increase in prevalence of LDL-C <70 mg/dL and LLT use improved from 77% to 86%.
Conclusion: VALOR-QI showed that addressing site-specific barriers using relatively inexpensive tools can significantly improve lipid management among Veterans with ASCVD.