Addressing current challenges in optimization of lipid management following an ACS event: Outcomes of the ACS EuroPath III initiative

Abstract

Background: Low-density lipoprotein cholesterol (LDL-C) lowering is key to reduce atherosclerotic disease progression and recurrent events for patients after acute coronary syndrome (ACS). However, LDL-C management for post-ACS patients remains challenging in clinical practice. Hypothesis: The ACS EuroPath III project was designed to optimize LDL-C management in post-ACS patients by promoting guideline implementation and translating existing evidence into effective actions. Methods: Three surveys targeting cardiologists (n = 555), general practitioners (GPs; n = 445), and patients (n = 662) were conducted in Europe, with the aim of capturing information on patient characteristics and treatment during acute phase, discharge and follow-up. GPs' and patients' opinions on key treatment aspects were also collected. Based on survey results, international experts and clinicians identified areas of improvement and generated prototype solutions. Participants voted to select the most feasible and replicable proposals for co-development and implementation. Results: Five key areas of improvement were identified: (1) inappropriate treatment prescribed at discharge; (2) lack of lipid guidance in the discharge letter; (3) inadequate lipid-lowering therapy (LLT) optimization; (4) gaps in guideline knowledge and lack of referral practices for GPs; (5) patients' concerns about lipid management.Proposed solutions for these focus areas included development of a treatment algorithm for the acute phase, a standardized GP discharge letter, an assessment tool for LLT efficacy at follow-up, an education plan for GPs/patients and a patient engagement discharge kit. The standardized GP discharge letter and treatment algorithm have been selected as the highest priority solutions for development.

World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update

“…Implementing protocols and/or decision support interventions that encourage and systematize the prescription of secondary prevention medications, lifestyle recommendations, and referral to cardiac rehabilitation can increase the systematic uptake of secondary prevention. Such post-MI interventions can include utilising post-discharge care coordinators, and leveraging electronic health record systems (e.g., incorporating decision support in electronic health record [EHR] and making cardiac rehabilitation referral the default option, i.e., from opt-in to opt-out option in the automated electronic health record) [ 198 199 200 ]. Additionally, offering all patients influenza vaccination after ACS before discharge or during cardiac rehabilitation (if not already vaccinated) [ 201 ] can have a beneficial effect.…”

“…To maximise the impact of secondary prevention interventions, it is also key to optimise the hospital discharge process after an acute cardiovascular event. rehabilitation referral the default option, i.e., from opt-in to opt-out option in the automated electronic health record) [198][199][200]. Additionally, offering all patients influenza vaccination after ACS before discharge or during cardiac rehabilitation (if not already vaccinated) [201] can have a beneficial effect.…”

Inclisiran in patients with acute ischemic stroke: first data

“…Возможно, именно инициация терапии малой интерферирующей РНК после ИИ уже в стационаре может рассматриваться как важный инструмент коррекции дислипидемии в реальной клинической практике с позиции изначального старта с ГЛТ адекватной мощности и снижения риска организационных и клинических ошибок при выборе ГЛТ на последующих этапах лечения пациента. Именно такой подход использует рабочая группа Европейского проекта с амбициозной целью достижения целевых значений у 76 % пациентов после острого коронарного синдрома в ближайшие 3 мес (ACS EuroPath III) после разви-ОРИГИНАЛЬНЫЕ СТАТЬИ § тия события, при этом рабочая группа проекта отмечает, что первой проблемой в достижении данной цели является именно отсутствие адекватно выбранной ГЛТ при выписке из стационара [38].…”