Regional Clinical Alliance Path for Secondary Prevention of Acute Coronary Syndrome - Impact on Low-Density Lipoprotein Cholesterol Levels.

Abstract

Background: The prognosis for survivors of acute coronary syndrome (ACS) remains substantially worse compared with the general population. In Japan, regional clinical alliance paths (RCAPs) have been promoted to support the secondary prevention of ACS within community settings. However, the implementation of RCAPs is currently low, and their clinical efficacy has not been established. This study evaluated the impact of RCAP implementation on secondary prevention outcomes in ACS patients.

Methods and results: Of 405 patients admitted to Tottori University Hospital for ACS between May 2020 and April 2023, 136 who underwent primary percutaneous coronary intervention (PCI) and received follow-up care at primary care clinics were included in the study. Sixty-five (47.8%) patients received care under an RCAP, whereas 71 received standard care. RCAP implementation was associated with a higher proportion of patients achieving low-density lipoprotein cholesterol (LDL-C) levels below 70 mg/dL and with greater reductions in LDL-C levels overall. Propensity score-weighted analysis confirmed that the RCAP group achieved significantly better LDL-C control after adjustment for baseline characteristics using inverse probability weighting.

Conclusions: RCAP implementation improved the rate of LDL-C target achievement and the degree of LDL-C reduction in post-ACS patients receiving follow-up care from family physicians. RCAP implementation is an effective strategy for the secondary prevention of ACS, particularly by enhancing adherence to established pharmacological therapies.