Abstract Body: Background: Optimal lipid management is critical for reducing cardiovascular events among those with atherosclerotic cardiovascular disease (ASCVD). When implementing LDL-C lowering methods, rural populations may often be disproportionately affected due to unique challenges such as an increased average distance from the nearest VA site and pharmacy.
Aims: This quality improvement program sought to determine whether a variety of lipid optimization strategies yielded similar benefits in veterans residing in rural versus urban areas in the US.
Methods: VALOR-QI was conducted among veterans with prevalent ASCVD at 50 VA sites across the US between December 2022 to June 2025. Veterans were assigned either urban or rural designation based on the Geographic Information System (GIS). At each of the 50 VA sites, American Heart Association consultants conducted an assessment to identify barriers to lipid management and worked with sites to implement strategies tailored to the identified barriers. The primary outcome was the proportion of veterans with LDL-C treated to target (<70 mg/dL) between baseline and 24 months. Secondary outcomes included changed during the program in prevalence of LLT use, adherence to LLT, and absolute reduction in LDL-C.
Results: A total of 11,827 veterans engaged in the program had repeated LDL-C data at 24 months. 8657 veterans were designated as urban and 3,170 were designated as rural. At 24 months, 34.5% of veterans in urban and 32.5% veterans in rural areas achieved LDL-C <70 mg/dL (p=003955). Mean LDL-C decreased by 16.1mg/dl for urban and by 15.9 mg/dl for rural veterans. Between baseline and 24 months, LLT use improved from 77.6% to 87.6% for urban and from 79% to 88% for rural. LLT adherence increased from 56.0% to 63.7% for urban and from 60.6% to 71.1% for rural veterans.
Conclusion: This quality improvement program with a health coach demonstrated that addressing site-specific barriers to lipid management resulted in improvement in lipid optimization in both rural and urban veterans after 24 months.