Closing Care Gaps After Acute Coronary Syndrome: A Pilot Program to Improve Secondary Prevention

After an acute coronary syndrome event, secondary prevention is critical but remains suboptimal in underserved populations.

Structural barriers, neighborhood deprivation, and clinical inertia create an implementation gap in lipid management, disproportionately affecting vulnerable patients.

LIICA (Lankenau Initiative to Improve Cardiovascular Access) is a multidisciplinary quality improvement program using the Area Deprivation Index to identify high-risk patients and enroll them in a coordinated pathway led by an advanced practice provider, interventional cardiologist, nurse navigator, community health worker (CHW), and pharmacists. The primary outcome was low-density lipoprotein cholesterol management; secondary outcomes included hemoglobin A1c, Duke Activity Status Index, blood pressure, sleep, anxiety, weight, body mass index, social needs resources, and hospital use. In this pilot cohort at 1 year, achievement of low-density lipoprotein cholesterol <55 mg/dL increased from 6.1% to 58.2%, mean hemoglobin A1c fell from 7.1% to 6.4%, Duke Activity Status Index and anxiety improved, and there were 0% second acute coronary syndrome events. Weight, body mass index, sleep, and blood pressure remained stable. CHWs provided substantial resources.

A multidisciplinary, CHW-led navigation model closes the lipid management implementation gap in high-deprivation populations, converting guideline targets into real-world outcomes.