An innovative multi-disciplinary cardiometabolic clinic for patients with atherosclerotic cardiovascular disease leads to improved risk factor optimisation compared to standard care

Abstract Background Despite therapeutic advances, patients with atherosclerotic cardiovascular disease (ASCVD) are at high risk of future events. We established an innovative multi-disciplinary cardiometabolic clinic for patients with ASCVD, delivering earlier guideline-directed secondary prevention, prompt intensification of lipid-lowering therapies and robust post-event follow-up. Herein, we evaluate the achievement of cardiometabolic risk factor targets between patients receiving standard care compared to the cohort managed via our multi-disciplinary team (MDT) model at one year post index event. Methods 74 patients treated for acute coronary syndrome (ACS) between June 2021 and March 2022 receiving standard care (consisting of one follow-up hospital appointment plus primary care monitoring) were compared to 188 patients treated for ACS between March 2022 and February 2024 managed via our cardiometabolic MDT (consisting of joint cardiology/endocrinology/renal consultant-led MDT review followed by specialist pharmacist-delivered clinics to optimise risk factors). Baseline lipid profiles, glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and estimated glomerular filtration rate (eGFR) were documented at time of event and at 12 months (+/- 3 months) in both groups. Low density lipoprotein cholesterol (LDL-C) was calculated using the Sampson equation. In keeping with ESC guidelines, targets were defined as LDL-C 1.8 mmol/L, HbA1c 53 mmol/mol and SBP as 130 mmHg. Results Mean age at event was 66 ± 11 years and 79% were male. Prior to the index event, 30% had diabetes, 53% had hypertension, 29% had hyperlipidaemia and 35% were already on a high-intensity statin; while 21% had eGFR 60ml/min/1.73m2. At 12 months, the percentage of patients in the MDT vs. standard care cohort achieving LDL-C 1.8 mmol/L, SBP 130mmHg and HbA1c53 mmol/mol targets were 69% vs. 56%, 59% vs. 55% and 80% vs. 69% respectively (p values 0.05) (Figure 1). At 12 months, the MDT cohort had achieved significantly greater reductions in LDL-C, SBP and HbA1c compared to the standard care cohort with a -1.06 vs. -0.53mmol/L reduction in LDL-C (p=0.01), -7.8 vs. +4.3mmHg in SBP (p=0.028), and -4.88 vs. +6.8mmol/mol in HbA1c (p=0.017) (Figure 2). There was no significant difference in change in eGFR between the MDT and standard care cohorts (-3.63 vs. -2.07ml/min/1.73m2, p=0.119). Conclusion Our innovative, collaborative and holistic approach to secondary prevention following ACS demonstrates significant advantages in supporting patients towards achieving lipid, glycaemic and blood pressure targets in comparison to standard practice. Longer-term follow-up is ongoing to ascertain impact of this care model on reducing risk of major adverse cardiovascular events.Percentage reaching risk factor targets Reduction in risk factor levels