Abstract 13666: Effectiveness and Durability of Remote Algorithmic Cholesterol Management

Abstract

Introduction: In collaboration with an insurer, a remote cholesterol management pilot in patients with elevated LDL cholesterol (LDL-C) with, or at increased risk of, ASCVD achieved an average 45% LDL-C reduction in program completers. A key question for this novel strategy is the durability of this benefit, reported here at 1 year vs LDL control in a matched cohort. Methods: 469 Blue Cross Blue Shield (BCBS) patients completed the Brigham-Lipid Optimization (B-LO) program between 2/2016-12/2017. Retrospectively, we identified a control cohort of non-BCBS commercial patients (n=3955) matched for demographic and clinical characteristics. A difference-in-differences analytic approach compared LDL-C changes as adjusted for sex, age, race, prior statin intolerance, diabetes, ASCVD, and prior LDL>190. Results: B-LO patients who completed the program achieved 45.3% greater reduction in LDL-C from baseline to program exit than observed among matched-control patients receiving standard of care. This greater LDL-C reduction occurred despite higher baseline LDL-C among B-LO participants vs controls, even after extensive matching. 99% of program participants reached LDL goal, vs 16% of control patients (p<0.01.). (Figure) At 1-year post intervention, adjusted estimates of being at LDL goal were 83% of intervention patients vs. 52% of control patients. Conclusions: A remote cholesterol algorithmic management program that reduced LDL-C effectively also achieved more durable LDL control 12 months post-intervention, and to a greater extent than in matched controls. The efficacy of remote LDL management may also offer longer term effectiveness than usual care, arguing for further study into scalability and economic feasibility of remote population-level health interventions.