ASCVD Risk Reduction Initiative
Project status
Collaborators
PI Oversight Committee
Kevin Volpp, MD, PhD (ASCVD Initiative PI)
Karen Glanz, PhD, MPH
David Asch, MD, MBA
Shivan Mehta, MD, MBA, MSHP
Alexander Fanaroff, MD
Mary Putt, PhD, ScD
Clinical Executive Council
Matthew Press, MD, MSc
Deborah Driscoll, MD
C. William Hanson, II, MD
Frank Ingari
Raina Merchant, MD, MSHP
Richard Wender, MD
Research Executive Council
Garret FitzGerald, Mc, FRES
Dan Rader, MD
Thomas Cappola, MD, ScM
Judith Long, MD
Research Operations
Laurie Norton, MA, MBE
Innovation leads
Funding
Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine (Clinical and Translational Science Awards Program of the National Institutes of Health) with institutional support from Penn Medicine
Opportunity
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in the United States and worldwide. While progress has been made, prevalence is still high due to poor uptake and adherence to medications, persistently unhealthy behaviors, and a system incentivized to treat rather than prevent.
Low-cost cardiovascular drugs could reduce cardiovascular events by 62 to 88 percent with perfect adherence. However, nationally, even when cardiovascular medications are made free, adherence is only about 45 percent in the year following a heart attack. At Penn Medicine, only about 60 percent of patients with or at high risk for ASCVD are on statins to help lower cholesterol, and only about 35 percent are at optimal blood pressure control. Although there are widely available, effective medications to lower blood pressure and cholesterol, medical breakthroughs do not improve population health if we do not overcome behavioral barriers to widespread use.
Intervention
The ASCVD Risk Reduction Initiative aims to develop an effective, scalable heart disease prevention program that reduces modifiable ASCVD risk by 30 percent in a population of Penn Medicine patients.
The ASCVD Risk Reduction Initiative will test a population health approach using best practices in behavioral science and digital health to develop a program that is easy and comfortable for patients and welcomed by clinicians. The program will focus on improving blood pressure and lipid control and incorporating support for smoking cessation, nutrition, and food insecurity.
| Current state of ASCVD risk reduction | Future state envisioned by ASCVD initiative |
|---|---|
| Reactive, visit-based model | Proactive outreach and prevention using data assets to identify and risk stratify patients in a population health approach |
| Fee for service | Value-based payments plus fee for service |
| Limited primary care provider (PCP) resources and workforce pipeline | Relieve overburdened PCPs using non-clinical navigators, applied informatics tools, and behavioral science best practices |
| Limited evaluation | Ongoing data insights and infrastructure to measure what works, and for whom, to develop insights from populations |
| Equity at the margins | Emphasis on equity in design and evaluation |
| Strategic partnerships status quo | Alignment with Tandigm partnership and expanded relationships with payors, tech, and others |
Impact
The ASCVD Initiative is currently learning from over 15 pilots, systematically testing the efficacy of behavioral science interventions on each lever of care – patient, provider, and system. The initiative aims to launch a clinical trial of Penn Medicine Healthy Heart, its comprehensive heart disease prevention program, in fall 2023, combining the best ideas from across the pilot portfolio.