The American College of Cardiology, through a strategic collaboration with Amgen and Esperion, is launching a new quality improvement campaign, “Driving Urgency in LDL Screening,” to increase the rate of diagnostic LDL screening in patients without a prior cardiac event as well as those with known cardiovascular disease to help clinicians identify those who need treatment in accordance with medical guidelines.
“Cardiovascular disease is preventable in many cases, and early identification of risk is essential, especially for people at high risk,” says ACC Chief Medical Officer Richard Kovacs, MD, MACC. “Through this program we’re transforming cardiovascular care and improving heart health for all by ensuring clinicians are informed of the latest screening recommendations and that patients have access to the highest quality care.”
Cardiovascular disease is the number one killer of men and women worldwide. The higher a person’s LDL, or “bad” cholesterol, the higher the chance of developing heart disease or having a heart attack or stroke. Evidence has shown that lowering LDL levels through lifestyle changes and/or medications can reduce a person’s risk of atherosclerotic cardiovascular disease (ASCVD).
In 2018, the ACC and American Heart Association released a guideline on the management of blood cholesterol recommending all people embrace a heart-healthy lifestyle to lower ASCVD risk, some people at higher risk take statin therapy to lower LDL levels, and clinicians continue to assess adherence and response to LDL-lowering medication and lifestyle changes. The guideline also recommends using the ASCVD Risk Estimator, which was developed in 2013 and today is the most widely used risk calculator. The calculator uses LDL levels, as well as other clinical factors, to inform patients and clinicians of cardiovascular disease risk and the beneficial effects of risk modification, such as reducing LDL levels.
Also, ACC released an expert consensus decision pathway (ECDP) in 2022 on the use of non-statin therapies for lowering LDL cholesterol in the management of ASCVD risk to outline recommendations for managing LDL in patients unable to take statins or in patients who need additional treatment to lower LDL; however, adherence to guideline-directed medical therapies as determined through active monitoring and management of LDL levels beyond the initial screening is highly variable, leaving many patients undertreated and at continued risk.
“The current reality is that not enough patients are getting screened for elevated LDL – this is especially alarming for those who have established ASCVD,” says Paul Burton, MD, PhD, senior vice president and chief medical officer, Amgen. “We see health care providers as a critical part of the solution but recognize that a shift of this scale requires assistance. We are proud to have joined forces with the American College of Cardiology and Esperion on this collaborative effort to increase doctor-directed screening and, ultimately, helping to improve cardiovascular care and patient outcomes.”
The New LDL Screening Program
“Driving Urgency in LDL Screening” is a new campaign to build awareness at the point of care and reinforce the importance of active LDL screening and treatment to reduce ASCVD risk. The national program is anticipated to reach about 30,000 primary care providers and cardiologists, through which ACC will assess current levels of LDL screening in their primary/secondary prevention ASCVD patients, test the implementation of various education/awareness messages among clinicians, and observe changes in the rate of LDL screening and treatment in the cohort over the course of a 12-month intervention.
The program will be guided by an independent ACC physician steering committee. Program participants will be provided with access to supporting resources such as the guideline and ECDP documents, the ASCVD Risk Estimator, and CardioSmart patient education materials at the point of care. The delivery of the program will be powered by Clint, the clinical intelligence platform. With Clint, participating practices will have the option to access practice-level and patient-level dashboards to track ASCVD risks and assess specific gaps in care. In addition, a comprehensive awareness and educational communication campaign about the program will be implemented in Veradigm’s Practice Fusion EHR at the point of care that is adjacent to but clearly distinguishable from the clinical and practice management workflows.
“We at Esperion are thrilled to partner with the ACC, Amgen, Veradigm, Clint and health care providers around the U.S. to improve and transform care for the millions of Americans with or at risk of cardiovascular events due to elevated LDL cholesterol,” says JoAnne Foody, MD, FACC, chief medical officer of Esperion. “Despite all we know about the importance of LDL-C goal attainment, only 27% of high-risk individuals achieve their recommended LDL-C level. Only with a national, multi-stakeholder program of this caliber will we be able to address these significant gaps, improve access to high quality care for all, and improve cardiovascular outcomes. Esperion is solely focused on our mission to improve heart health and proud to sponsor this national effort.”
Program participants will be assessed on their adherence to guideline directed medication therapy for lowering LDL over the course of a year, including repeat testing of LDL levels and the prescription of lipid-lowering medications as indicated and in shared-decision making with patients.