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July 18, 2026BMJ Open QualityOpen Access

Creating change through short-term pilots and rapid cycle testing: a case of cardiovascular risk reduction

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Why the study?

Despite effective and low-cost diagnosis and treatment options, scalable evidence-based strategies have not achieved optimal cardiovascular risk reduction.

Population

Patients with high modifiable ASCVD risk despite access to care at a large academic health system

Comparison

ASCVD Risk Reduction Initiative prevention programme implementation

Design

Case study of a learning health system model

Key result

The ASCVD Risk Reduction Initiative combined randomized trials, quality improvement, and rapid cycle testing to develop a scalable cardiovascular risk reduction program.

Authors

LALaura Ellen AshcraftKMKaty MahrajLNLaurie A Norton

Discussion

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Member takes

Overview

Supports testing of integrated ASCVD programs; leaves open real-world effectiveness before practice adoption.

Key Points

  • This research aims to demonstrate effective methods for reducing cardiovascular risk in high-risk patients.
  • Developed and evaluated a heart disease prevention programme over three years.
  • Utilized a combination of randomized controlled trials and quality improvement projects.
  • Incorporated rapid cycle testing and data analysis to refine strategies.
  • The ASCVD Risk Reduction Initiative showed initial success in lowering cardiovascular risk.
  • Challenges included scaling effective interventions within a large health system.
  • Insights from concurrent projects informed ongoing improvements.

Structured PICO

P
Population
A health system initiative involving 75,149 patients across multiple pilot studies to develop and evaluate innovative care models for atherosclerotic cardiovascular disease risk reduction.
I
Intervention
ASCVD Risk Reduction Initiative (a learning health system model combining RCTs, quality improvement projects, rapid cycle testing, and user research)

A learning health system approach combining rapid cycle testing, quality improvement, and traditional trials can be utilized to develop and scale cardiovascular risk reduction programs.

Limitations

  • Significant investment required in research operations, clinician socialization, and staff training
  • Separate EHRs between multiple sites and differences in workflows
  • Cross-use of staff in research and clinical tasks necessitated documenting in multiple systems
  • Inability to compare directly across pilot studies due to differences in eligibility, measures, and design
  • Challenges obtaining exit interviews with a fully representative sample of patients

Cite This Study

Ashcraft et al. (2026) studied Atherosclerotic cardiovascular disease (ASCVD) risk (n=75,149). ASCVD Risk Reduction Initiative was evaluated on Systolic BP and LDL-C at 6 months post randomisation (for the planned effectiveness trial). The ASCVD Risk Reduction Initiative combined randomized trials, quality improvement, and rapid cycle testing to develop a scalable cardiovascular risk reduction program.

synapsesocial.com/papers/6a5b38f68167787360d24dcchttps://doi.org/10.1136/bmjoq-2025-004001
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