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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Closing Care Gaps After Acute Coronary Syndrome

  • Stephanie Kjelstrom1
  • Mara Caroline1,2
  • Amanda McClendon2
  • Melanie DeCecco3
  • William Gray1,2
  1. 1Main Line Health Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
  2. 2Main Line Health Lankenau Heart Group, Wynnewood, Pennsylvania, USA
  3. 3Main Line Health, Wynnewood, Pennsylvania, USA
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Abstract

Background: After an acute coronary syndrome event, secondary prevention is critical but remains suboptimal in underserved populations.

Project Rationale: Structural barriers, neighborhood deprivation, and clinical inertia create an implementation gap in lipid management, disproportionately affecting vulnerable patients.

Project Summary: LIICA (Lankenau Initiative to Improve Cardiovascular Access) is a multidisciplinary quality improvement program using the Area Deprivation Index to identify high-risk patients and enroll them in a coordinated pathway led by an advanced practice provider, interventional cardiologist, nurse navigator, community health worker (CHW), and pharmacists. The primary outcome was low-density lipoprotein cholesterol management; secondary outcomes included hemoglobin A1c, Duke Activity Status Index, blood pressure, sleep, anxiety, weight, body mass index, social needs resources, and hospital use. In this pilot cohort at 1 year, achievement of low-density lipoprotein cholesterol <55 mg/dL increased from 6.1% to 58.2%, mean hemoglobin A1c fell from 7.1% to 6.4%, Duke Activity Status Index and anxiety improved, and there were 0% second acute coronary syndrome events. Weight, body mass index, sleep, and blood pressure remained stable. CHWs provided substantial resources.

Take-Home Message: A multidisciplinary, CHW-led navigation model closes the lipid management implementation gap in high-deprivation populations, converting guideline targets into real-world outcomes.

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Cite

BibTeXRIS
BibTeX
@article{kjelstrom2026closing,
  title = {{Closing Care Gaps After Acute Coronary Syndrome}},
  author = {Stephanie Kjelstrom and Mara Caroline and Amanda McClendon and Melanie DeCecco and William Gray},
  journal = {JACC Case Reports},
  year = {2026},
  month = sep,
  doi = {10.1016/j.jaccas.2026.110335},
  url = {https://doi.org/10.1016/j.jaccas.2026.110335},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Closing Care Gaps After Acute Coronary Syndrome
AU  - Stephanie Kjelstrom
AU  - Mara Caroline
AU  - Amanda McClendon
AU  - Melanie DeCecco
AU  - William Gray
PY  - 2026
DA  - 2026/09/16
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.110335
UR  - https://doi.org/10.1016/j.jaccas.2026.110335
AB  - Background: After an acute coronary syndrome event, secondary prevention is critical but remains suboptimal in underserved populations.  Project Rationale: Structural barriers, neighborhood deprivation, and clinical inertia create an implementation gap in lipid management, disproportionately affecting vulnerable patients.  Project Summary: LIICA (Lankenau Initiative to Improve Cardiovascular Access) is a multidisciplinary quality improvement program using the Area Deprivation Index to identify high-risk patients and enroll them in a coordinated pathway led by an advanced practice provider, interventional cardiologist, nurse navigator, community health worker (CHW), and pharmacists. The primary outcome was low-density lipoprotein cholesterol management; secondary outcomes included hemoglobin A1c, Duke Activity Status Index, blood pressure, sleep, anxiety, weight, body mass index, social needs resources, and hospital use. In this pilot cohort at 1 year, achievement of low-density lipoprotein cholesterol <55 mg/dL increased from 6.1% to 58.2%, mean hemoglobin A1c fell from 7.1% to 6.4%, Duke Activity Status Index and anxiety improved, and there were 0% second acute coronary syndrome events. Weight, body mass index, sleep, and blood pressure remained stable. CHWs provided substantial resources.  Take-Home Message: A multidisciplinary, CHW-led navigation model closes the lipid management implementation gap in high-deprivation populations, converting guideline targets into real-world outcomes.
SN  - 2666-0849
ER  -