Impact of a virtual lipid clinic on lipid-lowering therapy, LDL cholesterol levels, and outcomes in patients with acute coronary syndrome.

BACKGROUND: Atherosclerotic cardiovascular disease is a very common condition in routine practice and a leading cause of morbidity and mortality all around the world. OBJETIVE: To determine the impact of a strategy based on strict control and close follow-up for patients with acute coronary syndrome (ACS) through the use of "post-ACS virtual lipid visits" on lipid-lowering therapy, low-density lipoprotein cholesterol (LDL-c), and outcomes. METHODS: Prospective study that consecutively included patients with ACS during 2020. All patients were discharged with high-intensity statins, and the lipid profile was determined after 1 month. At this time, patients were contacted by phone, and treatment was adjusted following the therapeutic algorithm of the Spanish Society of Cardiology. These visits were repeated every month until LDL-c reached <55 mg/dL. Patients were then transferred to scheduled conventional outpatient visits. RESULTS: A total of 346 patients (67.3±2.3 years; 68.2% men) were included. Follow-up was 12-24 months (mean, 17.7±3.8; median, 17.3). Definitive lipid-lowering therapy (mean uptitration time, 3.2±2.1 months) consisted of high-intensity statins alone (32.4%), high-intensity statins plus ezetimibe (56.9%), and PCSK9 inhibitors (10.7%). LDL-c decreased from 108.4±40.6 to 48.7±14.4 mg/dL. At baseline, LDL-c was <100 mg/dL, 70 mg/dL, and 55 mg/dL in 44.5%, 17.6%, and 7.2% of patients, respectively. At study end, these percentages were 100%, 95.4%, and 81.5%, respectively. After one year of follow-up, 3-P MACE, 4-P MACE, and cardiovascular mortality were recorded in 3.5%, 4.0% and 1.5% of patients, respectively. At study end, these percentages were 4.0%, 5.2%, and 1.7%, respectively. CONCLUSIONS: The implementation of a post-ACS virtual lipid visit model led to early optimization of lipid-lowering therapy, which led to marked improvements in LDL-c control rates and low MACE and mortality rates.

Impact of Coronavirus-19 Pandemic and Lockdown on Admissions for Ischemic Heart Disease.

Background: In early 2020, the SARS-CoV-2 pandemic caused an unprecedented overload for the health service. A decrease in admissions for Acute Coronary Syndrome (ACS) was reported during lockdown, although many aspects remain to be clarified. The main objective of this study was to evaluate the impact of the pandemic and of lockdown itself in this area. Methods: We performed a retrospective observational study based on data from patients who visited the emergency department of a tertiary hospital with chest pain during 2018-2020, as well as those who were admitted for ACS. Personal details, date of admission, additional test results (laboratory and echocardiography), and therapy were recorded. Patients were divided into 3 groups: preCOVID (n=1,301), lockdown (n=45), and postlockdown (n=343). Results: Fewer visits to the emergency department for chest pain and admissions for ACS were recorded during lockdown (48.6% and 51.1% respectively, p<0.05). Patients who were admitted during lockdown were characterized by poorer control of cardiovascular risk factors, visited later (more evolving infarctions: 2.7% vs. 14.3%, p<0.05), experienced more echocardiographic complications during admission, and had more than 3-fold mortality rates (both in-hospital and postdischarge). Conclusion: The COVID-19 pandemic and lockdown itself had a negative effect on ischemic heart disease beyond SARS-CoV-2 infection.

Patient-Associated Predictors of 15- and 30-Day Readmission After Hospitalization for Acute Heart Failure.

BACKGROUND: Identifying readmission predictors in heart failure (HF) patients may help guide preventative efforts and save costs. We aimed to identify 15- and 30-day readmission predictors due to cardiovascular reasons. METHODS AND RESULTS: A total of 1831 patients with acute HF admission were prospectively followed during a year. Patient-associated variables were gathered at admission/discharge and events during follow-up. A multivariate Fine and Gray competing risk regression model and a cumulative incidence function were used to identify predictors and build a risk score model for 15- and 30-day readmission. The 15- and 30-day readmission rates due to cardiovascular reasons were 7.1% and 13.9%. Previous acute myocardial infarction, congestive signs at discharge, and length of stay > 9 days were predictors of 15- and 30-day readmission, while much weight loss and large NT-ProBNP reduction were protective factors. The NT-ProBNP reduction was larger at 30 days (> 55%) vs 15 days (> 40%) to protect from readmission. Glomerular filtration rate at discharge < 60 mL/min/1.73m2 and > 1 previous admissions due to HF were predictors of 30-day readmission, while first post-discharge control at an HF unit was a protective factor. CONCLUSIONS: Previous identified factors for early readmission were confirmed. The NT-ProBNP reduction should be increased (> 55%) to protect from 30-day readmission.