Mobilizing core and country-tailored implementation strategies to accelerate Lipoprotein(a) testing across Europe: findings from the Lp(a)CCELERATE contextual analysis

Background As part of an ongoing European multicentre implementation science study, a contextual analysis was conducted to identify core and country-tailored activities, defined as implementation strategies, and understand how these can be mobilized and combined to accelerate the adoption of lipoprotein(a) [Lp(a)] testing in routine cardiovascular care. Purpose This analysis aimed to determine how identified barriers and opportunities for Lp(a) testing could be addressed through targeted, country-tailored implementation strategies. Methods Following qualitative interviews (Phase I), a Delphi survey (Phase II) was completed by healthcare professionals (HCPs) across cardiology centres in the United Kingdom, Italy, and Germany. Country-specific consensus meetings (Phase III) were subsequently held with panellists from the same centres. Consensus was predefined as ≥80% agreement on a 9-point Likert scale, with identification of statements nearing consensus (>60%). Key domains explored included HCP awareness, local clinical settings and standard operating procedures (SOPs), clarity of clinical guidance and system-level infrastructure. Results Across 14 cardiology centres, 86 HCP interactions contributed to the contextual analysis. Overall, strong consensus was reached on the need for enhanced educational training and resources disseminated through local champions, with most participants reporting insufficient guidance on when and whom to test (87.9% and 84.8%, respectively), how to interpret Lp(a) results (81.8%), and how to act on findings (84.8%). Near-consensus (63.6%) supported the role of multidisciplinary teams in improving consistency of Lp(a) testing practice. Despite variation in infrastructure between countries, there was consensus on the need for standardized processes. Italy reported greater existing SOP standardization than the UK (71% vs 40%), with shorter anticipated timelines for protocol updates (<6 months vs >18 months). Aligning SOPs with patient presentation as the optimal testing point was supported in both countries (UK: 63.6%; Italy: 84.6%). UK participants viewed automated flagging and result notifications as clinically valuable but operationally challenging, while Italian participants anticipated feasible implementation within 6–12 months but limited clinical impact. Overall, 84.8% agreed Lp(a) should be integrated into cardiovascular risk assessment. Conclusions This European contextual analysis highlights educational gaps, insufficient guidance and process-related barriers to routine Lp(a) testing across cardiology centres. Participants supported aligning local SOPs and infrastructure with testing pathways. Variation in perceived feasibility across countries underscores the need for context-sensitive implementation strategies. These findings outline a practical roadmap for embedding routine Lp(a) testing, which will be evaluated as part of the Lp(a)CCELERATE study.