Integration of lipoprotein(a) testing into inpatient cardiology-lipid clinic pathway: A 2-year review of LILAC heart initiative using RE-AIM framework.

BACKGROUND

The LILAC heart is a novel implementation initiative that employs multipronged strategies with the LILAC-for-lipoprotein(a) [Lp(a)] clinical approach to integrate Lp(a) testing and management into inpatient cardiology care.

OBJECTIVE

At 2 years after implementation, we assessed the implementation outcomes.

METHODS

Reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) were used to evaluate the initiative's adoption and effectiveness. Small tests of change using 3 plan-do-study-act (PDSA) cycles conducted between November 2023 and November 2025 were reviewed.

RESULTS

Following implementation of LILAC Heart, the mean monthly testing rate increased from 6.6% to 80.4% in the acute myocardial infarction (AMI) pathway and from <0.01% to 45.6% in non-AMI admissions, with a total of 3191 patients tested (reach, effectiveness, and adoption). The overall detection rate of elevated Lp(a) ≥120 nmol/L was 16.2%, and Lp(a) ≥200 nmol/L was 7.0% (effectiveness). The referral rate to the lipid clinic was 53.7%, while 55.4% attended (adoption). The lipid clinic attender group, when compared with the nonattender group (n = 125 vs 158), had higher diagnosis codification rates for elevated Lp(a), higher prescription rates of lipid-lowering agents, and improved low-density lipoprotein cholesterol (LDL-C) levels and LDL-C goal attainment rates; all P < .05 (adoption, implementation, and effectiveness). Concomitant with the protocolization of the LILAC-for-Lp(a), multiple extensive collaborative education, training, and awareness efforts, PDSA cycle reviews, and the identification of champions were undertaken to address key barriers and promote sustainability (implementation and maintenance).

CONCLUSION

Reasons for the successful integration of Lp(a) into inpatient cardiology at 2 years after implementation included the LILAC clinical framework, accompanied by multipronged collaborative strategies undertaken by the multidisciplinary lipid and cardiology teams.