Abstract 4368559: Twelve-month Changes in Lipid Management among Veterans who worked with a Health Coach vs. those who did not in the Veterans Affairs Lipid Optimization Reimagined Quality Improvement (VALOR-QI) Program

Background: Lipid management is critical for reducing cardiovascular events among those with atherosclerotic cardiovascular disease (ASCVD). Barriers to lipid management are multifactorial, including process-level and patient-level factors, which may require a multipronged approach to address. Aims: To evaluate lipid lowering therapy (LLT) use and LDL-C levels at baseline and 12 months among Veterans who worked with a health coach (HC) vs. those who did not in the Veterans Affairs Lipid Optimization Reimagined Quality Improvement (VALOR-QI) Program. Methods: VALOR-QI is a national quality improvement collaboration between the US Department of Veterans Affairs (VA) and the American Heart Association (AHA) with the goal of improving lipid management among Veterans with ASCVD across 50 VA sites. While some sites focused on process-level approaches, others additionally had a HC work directly with Veterans, providing education on the importance of LLT and lifestyle modifications and coordinating referrals to local programs (e.g., Whole Health). Data were analyzed from Veterans with ASCVD and a baseline LDL-C ≥ 70 mg/dL who received care from a VALOR-QI provider during the program, had 12 months pass since their first visit, and had at least two lipid labs during that time. We investigated changes in LLT use and LDL-C in Veterans who worked with a HC vs. those who did not. Results: Among Veterans included in the analysis, 2,093 worked with a HC [mean (SD) age 70 (9.8) years, 93% men, 64% white race], and 37,834 did not [mean (SD) age 70 (10) years, 93% men, 70% white race]. Both groups experienced improvements in LLT use and LDL-C levels, though Veterans who worked with a HC saw greater improvements in statin + additional LLT use (15% vs. 7%), LLT adherence (24% vs. 14%), percent meeting LDL-C goal <70mg/dL (40% vs. 31%), and mean LDL-C (-25.5 vs. -14.7 mg/dL). Conclusion: Among US Veterans in VALOR-QI, both those who worked with a HC and those who did not saw improvements in LLT use and LDL-C at 12-month follow-up, although improvements in some metrics were greater in Veterans working with a HC.