Project on lipid profile optimization in very high cardiovascular risk patients through a virtual lipid unit in our city healthcare area

Abstract Introduction and Objectives: Approximately 1200 patients with atherosclerotic coronary artery disease are admitted annually to the Cardiology Department at the University Hospital of Toledo. These patients are discharged with high-intensity statins and/or ezetimibe. However, there is a high rate of therapeutic inertia among these patients, many of whom are not reassessed for treatment adjustment. It is estimated that 60% present with LDL-C levels above 55 mg/dL. Referring these patients to a Virtual Lipid Unit for telematic evaluation between 4-6 weeks post-discharge to assess initial treatment response and optimize therapy if necessary could improve lipid control. The objective is to establish a streamlined and standardized patient flow mechanism to optimize lipid-lowering therapy, aiming to reduce residual cardiovascular risk early. This protocol implements changes in the care pathway and incorporates telemedicine aspects to expedite follow-up and therapeutic control. Additionally, it facilitates data collection for evaluating project outcomes and supporting future studies in this field. Material and Methods: - Requesting a specific lipid profile test to be performed at the patient’s primary care center 4-6 weeks post-discharge. - Analyzing LDL-C levels telematically at 4-6 weeks post-discharge and adjusting treatment if necessary according to guidelines. If a new treatment adjustment is required, a follow-up lipid profile will be requested for 4-6 weeks later. - Reevaluating LDL-C levels at 4-6 weeks by Primary Care if the patient remains on oral lipid-lowering therapy (in cases of unmet targets at the first telematic visit). - Reevaluating LDL-C levels at 6 months by the Virtual Lipid Unit (Cardiology) in person if injectable lipid-lowering therapy is needed (in cases of unmet targets at the first telematic visit). - Evaluating the percentage of patients who reach target levels at 4-6 weeks and the percentage who achieve target levels after telematic medication adjustment. Results: Evaluation of 1345 patients over one year. 1. Use of High-Intensity Statins/Ezetimibe: - Pre-consultation: 38% (95% CI: 35.4% - 40.6%). - Post-consultation: 71% (95% CI: 68.6% - 73.4%). - Absolute difference: +33 percentage points (Z = -17.19, p < 0.001). 2. Lipid Control Target Achievement: - Pre-consultation: 34% (95% CI: 31.5% - 36.5%). - Post-consultation: 49% (95% CI: 46.3% - 51.7%). - Absolute difference: +15 percentage points (Z = -7.89, p < 0.001). Conclusions: The results of this study highlight the role of virtual consultation in optimizing lipid-lowering therapy. The increase in high-intensity statin and ezetimibe use reflects better adherence to treatment guidelines, resulting in a higher proportion of patients achieving lipid control targets. These findings suggest that telemedicine can be an effective tool for improving treatment quality in dyslipidemia patients, reducing access barriers and facilitating clinical follow-up.