Bridging the gap: enhancing lipoprotein(a) testing and education in federally qualified health centers

Abstract

Funding

Yes, Novartis is proud to support the American Heart Association's Lp(a) Federally Qualified Health Centers Discovery Project.

Background/Synopsis

Lipoprotein(a) [Lp(a)] is a significant genetic risk factor for atherosclerotic cardiovascular disease (ASCVD), particularly among Black/African American and South Asian populations who have been shown to have higher levels of Lp(a) compared to other groups. These populations are served by Federally Qualified Health Centers (FQHCs), which provide critical care to under-resourced and high-risk communities.

Objective/Purpose

The American Heart Association's (AHA) 3-year Lp(a) FQHC Discovery Project aims to assess current practices and identify barriers to Lp(a) testing in FQHCs, establish site-specific improvement goals, enhance clinician knowledge of Lp(a) and its role in ASCVD risk management, and improve patient education to support shared decision-making between clinicians and patients.

Methods

The AHA selected 10 FQHCs based on their 1) capacity to implement quality improvement (QI) initiatives, 2) patient education practices, 3) patient demographics, and 4) rural-urban classification. In-person qualitative interviews were conducted with clinical and quality champions to map current clinical workflows and patient pathways, identify barriers and establish goals for Lp(a) testing. The AHA program consultants analyzed the results to identify opportunities for integrating Lp(a) testing into clinical care. Proposed Lp(a) testing strategies were incorporated into monthly virtual consultations led by an AHA QI Consultant. Quarterly learning collaboratives provide opportunities to share progress, exchange best practices, and refine strategies. Findings from another initiative, the Lp(a) Discovery Project, which gathered insights from health systems with established Lp(a) testing practices, support the development of educational resources for the FQHCs.

Results

The cohort collectively serves over 250,000 patients including priority populations at higher risk for elevated Lp(a) levels. Baseline assessments identified barriers such as patient and clinician engagement and education, staffing, and testing costs. Notably, no significant out-of-pocket costs for Lp(a) testing have been reported by patients. Podcasts, webinars, and an eModule were developed for clinician education on Lp(a) testing, while a health lesson, care kit, infographics, and video were developed in consultation with FQHCs for culturally relevant patient education. The in-person interviews and consultations revealed that annual visits are the best opportunity for clinicians to recommend and educate patients on Lp(a) testing.

Conclusions

The Lp(a) FQHC Discovery Project highlights the importance of targeted interventions to enhance clinician and patient education, boost engagement, and increase testing rates, ultimately aiming to reduce ASCVD risk in under-resourced populations and address cardiovascular health disparities.