24 million aren’t getting the statins they need. Let’s fix that.

Jennifer Lubell , Contributing News Writer

About 930,000 U.S. adults die every year due to heart attacks and strokes. Treating high cholesterol with effective medications such as statins helps prevent heart attacks and strokes. Tragically, such treatments are dramatically underused, with more than 24 million adults in the U.S. not getting guideline-recommended statin treatment. 

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The AMA recently teamed up with the Centers for Disease Control and Prevention (CDC) on an educational tool that offers a four-part solution to address this problem. The “Cholesterol Management Change Package” from the AMA, CDC’s Million Hearts and National Association of Community Health Centers offers pragmatic guidance to help physicians and care teams improve their care of patients who can benefit from cholesterol treatment.

Statins are recommended to help more than 46 million adults in the U.S. cut their risk of atherosclerotic cardiovascular disease. And “while there are inexpensive, readily available medications and well-accepted guidelines for the management of elevated cholesterol, more than half of people who would benefit from a statin are not on one,” said Hilary K. Wall, MPH, CDC’s senior scientist for Million Hearts.

The change package offers evidence-based methods to improve care processes related to cholesterol management that would lead to significant reduction of cardiovascular morbidity and mortality, said Wall. It is designed for physicians as well as quality-improvement leaders, nurses, pharmacists and care managers. 

There are four focus areas of the change package. They are:

  • Key foundations. Making cholesterol management a practice or system priority, such as designating a cholesterol champion and implementing policies to address dyslipidemia for patients with high cholesterol at every visit.
  • Equipping care teams. Training teams on cholesterol management, optimizing lipid panel procedures and training teams to provide appropriate medications.
  • Population health management. Identifying high-risk patients who could benefit from a statin or may have undiagnosed familial hypercholesterolemia and using a registry to track and manage these patients.
  • Individual patient support. Preparing patients before office visits through pre-visit outreach and supporting patients in cholesterol self-management during routine daily activities.

From the change package, here is how physicians and health systems can address cholesterol management.

The key foundations section outlines components that a physician practice should put in place prior to starting their quality improvement efforts.

“I recommend first identifying a clinical champion who can secure the commitment from the rest of the team to work on this issue. Then, assemble key team members to review the change package, discuss ideas, and identify specific activities that your practice can implement to improve care,” said Kate Kirley, MD, MS, the AMA’s director of chronic disease prevention.

Once policies and workflows have been developed to support cholesterol management, it’s crucial to train the care team so they are prepared to implement them, added Dr. Kirley. “Care team training should be specific to each team member’s role in the process, and training should include topics like reviewing clinical guidelines and best practices to address barriers to optimal care.”

Kaiser Permanente Northern California, for example, has a cardiovascular physician champion who collaborates with doctors, department heads, clinical managers and ancillary staff. This helps with organizing and implementing the health system’s cardiovascular risk reduction program.

Several Permanente Medical Groups, the multispecialty physician groups that provide care to Kaiser Permanente members, are members of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine. 

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Addressing the additional focus areas, Wall emphasized that the new advice on cholesterol management isn’t designed to guide patient care or supplant clinical judgment and guidelines.

Rather, the change package “offers system-level implementation strategies, like practice-specific standardized treatment protocols, to optimally deliver evidence-based interventions,” she said. “For each strategy, we have gathered tested tools and resources from clinicians in the field to foster implementation.”

The population-health management section is especially important, Wall added. Physicians are often asked to complete a long list of prevention, screening and treatment tasks during a short patient visit.

“Let’s harness the power of technology to help make this easier by identifying groups of patients who could potentially benefit from cholesterol screening or statin use,” she said. Patient registries, performance dashboards and EHR alerts can better streamline the delivery of those services.

Supporting patients as important members of the care team is also vital, Wall said. The change package has lots of tools and resources to boost shared decision-making between patients and physicians and give patients information that helps them manage their cholesterol.

These include self-management plans, medication adherence, dietary changes, increasing physical activity and avoiding non-evidence-based supplements.