1021-P: Targeting Lower LDL Levels in Patients with Diabetes and ASCVD through a Novel Healthy Heart Program

Abstract

The US prevalence of ASCVD with DM in the elderly has been reported to be 50%. This population is at significant risk for future CV complications. (1) Aggressive management of dyslipidemia in the primary care setting should be a central focus to reduce associated morbidity and mortality. (2) Current US LDL targets for pts with DM are < 70 mg/dl. Recent ESC/EAS Guidelines in pts with DM and ASCVD, defined as a very high risk (VHR) population, target LDL levels at <55 mg/dl. (3) This study evaluates the impact of a protocol driven program, Healthy Heart (HH), in achieving lower LDL levels in elderly Medicare Advantage pts with DM and ASCVD in the primary care setting. The HH program is a pre-defined intervention protocol administered by specially trained APRNs in primary care offices, with cardiology oversight. Continuity with PCP directed care was maintained. At each visit, ASCVD risk factors were measured and managed along with recommended lifestyle modification. In the first year, 421 pts referred to HH had DM with established ASCVD. Baseline and final LDL values along with high intensity statin (HIS) use are reported. Demographics: Mean age 75+/-5.9 YO, 69% F, 84% Hispanic/Latino, <1% AA, BMI 30.0+/-5.3 kg/m², previous CABG 38%, CHF 24%, Carotid AD 23%, and prior stroke/TIA 3%. Mean time between baseline and final LDL was 320+/-107 days. The average number of HH visits was 3.5+/-1.7. Results: At baseline, 12.5% of the cohort had an LDL of <70 mg/dl, significantly improving to 55.1% after intervention. For the lower LDL target of <55 mg/dl, 10.6% of the cohort were at target improving to 29.2%, the use of HIS therapy improved from 40.3% at baseline to 84.3%. All findings were significant (P< 0.0001). Conclusion: Using a pre-defined protocol administered by APRNs in a primary care setting significantly improved the percentage of VHR patients achieving LDL targets of <70 and <55 mg/dl. The use of HIS more than doubled. Additional study to evaluate clinical outcomes is warranted. Disclosure E.Antunez: None. R.E.Kenney: None. R.Aguilar: None. V.Mccloskey: None. J.Rivera: None.