Background: Cardiovascular (CV) disease is the leading cause of death worldwide, accounting for nearly eighteen million deaths annually. Among patients with acute coronary syndrome (ACS), up to twenty percent experience a recurrent major adverse cardiovascular event (MACE) within two years. Optimizing lipid lowering therapies to achieve a goal low-density lipoprotein (LDL) is a cornerstone of secondary prevention and reduces the residual risk of MACE. Injectable-lipid lowering therapies have a prominent role in LDL goal achievement for patients deemed statin-intolerant or those who need additional lipid-lowering in addition to their maximally tolerated statin therapy. Despite the proven efficacy of injectable lipid-lowering therapies, their usage remains suboptimal due to access, cost, and workflow barriers. Pharmacist-led lipid clinics have shown to bridge the gap to initiation of injectable lipid-lowering therapy by increasing the use of guideline-directed therapy, identifying and managing statin-intolerance, and improved calculated low-density lipoprotein (LDL-C) goal achievement. This project evaluates the impact of an inpatient pharmacist-led referral process to a pharmacist-managed lipid clinic on the timely initiation of injectable lipid-lowering therapies in post-ACS patients. Methods: This single-center, retrospective cohort with pre-post analysis included adults who survived hospitalization for ACS, including non-ST-elevated myocardial infarction (NSTEMI) or ST-elevated myocardial infarction (STEMI), with an LDL greater than or equal to 55 mg/dL or statin-intolerant. Patients were excluded if they were already on injectable lipid-lowering therapy or pregnant or breastfeeding. Patients who met the inclusion criteria were eligible to be referred by the inpatient pharmacy team to a pharmacist-led lipid clinic for ambulatory lipid management post-ACS. A collaborative practice agreement (CPA) allowed clinical pharmacists practitioners (CPPs) to independently conduct lipid management visits, initiate, titrate, or discontinue antihyperlipidemic medications, order and evaluate laboratory tests, provide adherence and lifestyle counseling, and document all care in the electronic health record for physician review. The primary outcome assessed was the proportion of patients that were started on injectable lipid lowering therapy within four weeks of discharge post-ACS event. Secondary outcomes were proportion of patients started on injectable lipid lowering therapy within 12 weeks of discharge post-ACS event, proportion of patients seen in lipid clinic within four and 12 weeks of discharge post-ACS event, median time to seen in lipid clinic, median time to started on injectable lipid-lowering therapy post-discharge, and percent reduction of LDL from baseline to eight or more weeks post-initiation of injectable lipid-lowering therapy. Results: A total of 196 patients were screened with 45 patients being included in the pre-PharmD referral group and 151 patients in the post-PharmD referral group. A higher proportion of patients in the post-referral to pharmacist-managed lipid clinic group were initiated on injectable lipid-lowering therapies within four weeks of ACS discharge compared to the pre-referral group [15 (23.8%) vs 0 (0%); p=0.002]. Patients in the post-referral group were also more likely to be seen in lipid clinic within four weeks (OR 0.13; p=0.003) and 12 weeks (OR 0.32; p=0.04) of discharge. Conclusion: Implementation of a standardized referral process to an outpatient pharmacist managed lipid clinic post-ACS discharge enhance transitions of care and implementation of guideline-directed lipid-lowering therapy to reduce residual risk of MACE for patients post-ACS. This standardized process increased the number of patients seen by a pharmacist and initiated on injectable lipid-lowering therapies within four and 12 weeks of ACS discharge. These findings suggest that pharmacist-managed lipid clinics can bridge the gap in post-ACS care by ensuring lipid therapy optimization to reduce the risk of recurrent MACE. Presentation Objective: Describe the impact of an inpatient pharmacist-led referral process to an outpatient pharmacist-managed lipid clinic on the initiation of injectable lipid-lowering therapies in post-ACS patients. Self-Assessment: What are some advantages of referring post-ACS patients to an outpatient pharmacist-led lipid clinic?
