Abstract 4147587: Missed Opportunities To Optimize Lipid-lowering Therapy Following Revascularization In Patients With ASCVD

Introduction: Although attainment of LDL-C levels < 70 mg/dl with lipid lowering therapy (LLT) is associated with decreased rates of ASCVD events, up to 58% of patients have LDL-C > 70 mg/dL one year after coronary revascularization and <50% have their LLT intensified. Research Questions: Following revascularization for ASCVD, how often do clinicians have the opportunity to obtain follow-up lipid profiles and intensify LLT? Goals: Evaluate the number of ambulatory care (AC) visits at which follow-up lipid profiles and/or LLT intensification failed to occur (e.g., missed opportunity) following revascularization in patients with ASCVD. Methods: We report a retrospective cohort study evaluating lipid management following revascularization for ASCVD of the coronary, cerebral, or peripheral arteries between July 2021 – July 2022. Patients were identified from procedure lists. Exclusion criteria included baseline LDL-C < 70 mg/dl, triglycerides > 500 mg/dl, dialysis dependence, and no follow-up care within 6 months of revascularization. The number of AC visits with a provider and LLT intensification following revascularization were compared between patients with a follow-up lipid panel versus those without within 15 months post-revascularization. Logistic regression was performed to identify characteristics associated with obtaining a follow-up lipid profile. Results: Of the 159 patients included, 69 (43%) had a follow-up lipid panel for evaluation at an average of 162±115 days after revascularization; 35 (22% of the entire cohort) achieved an LDL <70 mg/dL. Patients with a follow-up lipid panel had significantly more AC visits and had higher rates of LLT intensification than those without follow-up lipids (Figure). Among the 90 patients without follow-up lipid profiles, there were a total of 363 missed opportunities to reassess lipids. Follow-up with either cardiology (OR 5.8 [95% CI 1.4-24.2]) or primary care (OR 4.1 [95% CI 1.8-9.3]) and diabetes (OR 2.7 [95% CI 1.2-5.9]) were positively associated with follow-up lipids; follow-up with vascular surgery (OR 0.2 [95% CI 0.0-0.9]), and heart failure (OR 0.2 [95% CI 0.1-0.8]) or CKD (OR 0.4 [95% CI 0.2-1.0]) were negatively associated with follow-up lipid panels. Conclusion: Post-revascularization care of high-risk ASCVD patients is suboptimal; we identified many missed opportunities to reassess lipids and intensify LLT.