Preliminary results of a multifaceted intervention to improve guideline-directed lipid-lowering therapy in patients with recent MI

Abstract

Funding

This research (the LOGAN-CV study)was sponsored by Amgen Inc.

Background/Synopsis

Most patients with atherosclerotic cardiovascular disease (ASCVD) do not achieve guideline-recommended LDL-C < 70 mg/dL. Effective interventions are urgently needed to reduce risk of recurrent CV events. Within the Premier, Inc. hospital network, we conducted a multicenter single-arm interventional study (LOGAN-CV) to improve lipid management in high-risk, post-myocardial infarction (MI) patients.

Objective/Purpose

To evaluate whether a 1-year multifaceted intervention improves lipid-lowering therapy (LLT) intensification and LDL-C control in statin-treated adults who had an MI in the past year and had uncontrolled LDL-C.

Methods

Clinicians with patients who met inclusion criteria (age ≥ 21, acute MI, statin treatment, LDL-C ≥ 70 mg/dL) during the year prior to start of the intervention were recruited from 7 sites. Clinician-focused interventions included custom cholesterol guideline and LLT education modules and a personalized dashboard of LDL-C and LLT-related patient metrics. Index date is the end of clinician education and baseline is 12 months before the index. This preliminary analysis includes the 2 sites that have completed the 1-year intervention.

Results

The 2 completed sites had 15 clinicians and 126 patients. Mean patient age was 65.7 years (SD=13.4), 56% were women, 63% white, 29% black, 36% had diabetes, 41% had obesity, and 54% had hypertension (Table). Patients’ most recent MI occurred a mean of 4.5 months (SD=3.1) prior to index, with 31% receiving PCI, 7.1% receiving CABG, and 62% medical management only. At index, majority of patients were prescribed moderate- (25%) or high-intensity (73%) statin. Ezetimibe was prescribed in 13% (n=17) of patients in combination with moderate- (n=3) or high- (n=14) intensity statin. During the 1-year intervention, 10% of patients had 1 recurrent MI and 21% had 2 recurrent MIs. LLT intensification occurred in 17% of patients (8.7% statin intensification, 4.8% ezetimibe addition, 3.2% PCSK9i mAb addition) (Figure). Only 64% (n=80) patients had LDL-C tests ordered. Median (Q1, Q3) LDL-C decreased from 90 (78, 110) mg/dL at index (n=126) to 71 (54, 94) mg/dL at month 12 of follow up (n=79), and 40/126 (32%) patients reached LDL-C control (<70 mg/dl) in an average of 5.4 (SD=3.2) months, and 16% reached LDL-C <55 mg/dL in an average of 6.3 (SD=3.2) months.

Conclusions

During a 1-year, multifaceted intervention to improve lipid management in patients with recent MI and uncontrolled LDL-C, 32% of patients reached the guideline-recommended LDL-C of < 70 mg/dL. Additional efforts to this intervention are needed to improve LDL-C testing and LDL-C control in these high-risk patients to prevent recurrent events.