Closing Care Gaps After Acute Coronary Syndrome: A Pilot Program to Improve Secondary Prevention.

BACKGROUND

After an acute coronary syndrome event, secondary prevention is critical but remains suboptimal in underserved populations.

PROJECT RATIONALE: Structural barriers, neighborhood deprivation, and clinical inertia create an implementation gap in lipid management, disproportionately affecting vulnerable patients.

PROJECT SUMMARY: LIICA (Lankenau Initiative to Improve Cardiovascular Access) is a multidisciplinary quality improvement program using the Area Deprivation Index to identify high-risk patients and enroll them in a coordinated pathway led by an advanced practice provider, interventional cardiologist, nurse navigator, community health worker (CHW), and pharmacists. The primary outcome was low-density lipoprotein cholesterol management; secondary outcomes included hemoglobin A1c, Duke Activity Status Index, blood pressure, sleep, anxiety, weight, body mass index, social needs resources, and hospital use. In this pilot cohort at 1 year, achievement of low-density lipoprotein cholesterol <55 mg/dL increased from 6.1% to 58.2%, mean hemoglobin A1c fell from 7.1% to 6.4%, Duke Activity Status Index and anxiety improved, and there were 0% second acute coronary syndrome events. Weight, body mass index, sleep, and blood pressure remained stable. CHWs provided substantial resources.

TAKE-HOME MESSAGE: A multidisciplinary, CHW-led navigation model closes the lipid management implementation gap in high-deprivation populations, converting guideline targets into real-world outcomes.