Promoting lipoprotein(a) awareness and testing for risk identification through outreach and teaching (PATRIOT-QI)

Background/Synopsis

Elevated Lipoprotein(a) [Lp(a)], is a genetically determined, highly heritable form of dyslipidemia, independently associated with coronary heart disease, peripheral artery disease, and calcific aortic stenosis. Despite being a well-established cardiovascular (CV) risk factor supported by existing guidelines, screening remains limited, particularly within the Veterans Affairs (VA) hospitals. While targeted Lp(a) lowering therapies are under investigation, addressing other modifiable CV risk factors remains critical for reducing overall CV disease burden.

Objective/Purpose

The National Lipid Association (NLA) recommends measuring Lp(a) levels at least once in all adults for CV risk assessment. This Quality Improvement (QI) initiative aimed to evaluate and improve adherence to the NLA screening guidelines by implementing targeted educational interventions in an outpatient setting.

Methods

This single-center QI project employed the Plan-Do-Study-Act framework. Baseline Lp(a) screening data were collected retrospectively from electronic medical records (EMRs) of health profession trainee (HPT) driven and attending practices at the VA between April 2024 to July 2024. To increase provider awareness and testing, a series of educational interventions were implemented. These included educational flyers distributed via email and displayed at HPT workstations; biweekly educational emails sent during the first two months of intervention, focusing on the clinical relevance of Lp(a) testing; and in-person presentations consisting of two educational sessions (October 2024 and December 2024) with HPTs to review Lp(a)’s clinical significance and the NLA guidelines.

Following these interventions, EMRs of HPT and attending clinic patients between August 2024 to December 2024 were reviewed to evaluate their impact.

Results

A total of 198 patients were included in this study. In the pre-intervention phase, 8 Lp(a) tests were ordered by 5 providers: 4 attending physicians, 1 Nurse Practitioner (NP). No tests were ordered by HPTs (Figure 1). Among those tested, 2 patients (25%) had elevated Lp(a) levels. In the post-intervention phase, 190 tests were ordered by 30 providers: 7 attending physicians, 3 NPs, 20 HPTs (Figure 1). Among those tested, 82 (43.16%) had elevated Lp(a) levels. Screening rates demonstrated a notable upward trend post-intervention (Figure 2).

Conclusions

Educational interventions yielded an approximate 24-fold increase in Lp(a) screening. This expanded testing detected a larger proportion of patients who would have otherwise remained undetected as high risk, offering additional opportunities to optimize treatment and address modifiable risk factors. These findings demonstrate the efficacy of targeted education in improving early detection, risk stratification, and management of elevated Lp(a). Our future objectives involve expanding these interventions to our two other HPT sites.