Integration of lipoprotein(a) testing into inpatient cardiology-lipid clinic pathway: A 2-year review of LILAC heart initiative using RE-AIM framework

BACKGROUND: The LILAC heart is a novel implementation initiative that employs multipronged strategies with the LILAC-for-lipoprotein(a) [Lp(a)] clinical approach to integrate Lp(a) testing and management into inpatient cardiology care. OBJECTIVE: At 2 years after implementation, we assessed the implementation outcomes. METHODS: Reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) were used to evaluate the initiative's adoption and effectiveness. Small tests of change using 3 plan-do-study-act (PDSA) cycles conducted between November 2023 and November 2025 were reviewed. RESULTS: Following implementation of LILAC Heart, the mean monthly testing rate increased from 6.6% to 80.4% in the acute myocardial infarction (AMI) pathway and from <0.01% to 45.6% in non-AMI admissions, with a total of 3191 patients tested (reach, effectiveness, and adoption). The overall detection rate of elevated Lp(a) ≥120 nmol/L was 16.2%, and Lp(a) ≥200 nmol/L was 7.0% (effectiveness). The referral rate to the lipid clinic was 53.7%, while 55.4% attended (adoption). The lipid clinic attender group, when compared with the nonattender group (n = 125 vs 158), had higher diagnosis codification rates for elevated Lp(a), higher prescription rates of lipid-lowering agents, and improved low-density lipoprotein cholesterol (LDL-C) levels and LDL-C goal attainment rates; all P < .05 (adoption, implementation, and effectiveness). Concomitant with the protocolization of the LILAC-for-Lp(a), multiple extensive collaborative education, training, and awareness efforts, PDSA cycle reviews, and the identification of champions were undertaken to address key barriers and promote sustainability (implementation and maintenance). CONCLUSION: Reasons for the successful integration of Lp(a) into inpatient cardiology at 2 years after implementation included the LILAC clinical framework, accompanied by multipronged collaborative strategies undertaken by the multidisciplinary lipid and cardiology teams.