Treatment in a preventive cardiology clinic utilizing advanced practice providers effectively closes atherosclerotic cardiovascular disease risk-management gaps among a primary-prevention population compared with a propensity-matched primary-care cohort: A team-based care model and its impact on lipid and blood pressure management

Abstract

Background: Advanced practice providers (APPs) can fill care gaps created by physician shortages and improve adherence/compliance with preventive ASCVD interventions.

Hypothesis: APPs utilizing guideline-based algorithms will more frequently escalate ASCVD risk factor therapies.

Methods: We retrospectively reviewed data on 595 patients enrolled in a preventive cardiology clinic (PCC) utilizing APPs compared with a propensity-matched cohort (PMC) of 595 patients enrolled in primary-care clinics alone. PCC patients were risk-stratified using Framingham Risk Score (FRS) and coronary artery calcium scoring (CACS).

Results: Baseline demographics were balanced between the groups. CACS was more commonly obtained in PCC patients (P < 0.001), resulting in reclassification of 30.6% patients to a higher risk category, including statin therapy in 26.6% of low-FRS PCC patients with CACS ≥75th MESA percentile. Aspirin initiation was higher for high and intermediate FRS patients in the PCC (P < 0.001). Post-intervention mean LDL-C, non-HDL-C, and triglycerides (all P < 0.05) were lower in the PCC group. Compliance with appropriate lipid treatment was higher in intermediate to high FRS patients (P = 0.004) in the PCC group. Aggressive LDL-C and non-HDL-C treatment goals (<70 mg/dL, P = 0.005 and < 130 mg/dL, P < 0.001, respectively), were more commonly achieved in high-FRS PCC patients. Median post-intervention SBP was lower among intermediate and low FRS patients (P = 0.001 and P < 0.001, respectively). Cumulatively, this resulted in a reduction in median post-intervention PCC FRS across all initial FRS risk categories (P < 0.001 for all).

Conclusions: APPs within a PCC effectively risk-stratify and aggressively manage ASCVD risk factors, resulting in a reduction in post-intervention FRS.

Keywords: Atherosclerosis; Blood Pressure Control and Regulation; Computed Tomography; General Clinical Cardiology/Adult; Imaging; Preventive Cardiology.

Figure 1

Observed LDL changes. (A) Median (IQR) initial and post‐intervention LDL‐C values in the PCC and PMC cohorts; (B) median (IQR) initial and post‐intervention LDL‐C values PCC patients who underwent CACS stratified by CACS < or > 100 arbitrary units; (C) mean LDL‐C changes post‐intervention in the PCC and PMC groups (P < 0.05 for follow‐up LDL‐C between all FRS groups). Abbreviations: CACS, coronary artery calcium scoring; FRS, Framingham Risk Score; IQR, interquartile range; LDL‐C, low‐density lipoprotein cholesterol; PCC, preventive cardiology clinic; PMC, propensity‐matched cohort

Figure 2

Changes in median FRS predicted 10‐year ASCVD risk at initial and post‐intervention in PCC and PMC groups. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; FRS, Framingham Risk Score; PCC, preventive cardiology clinic; PMC, propensity‐matched cohort