Global Point of Care

Lipid Screening Keeps Hearts Beating

lipid-screening-keeps-hearts-beating

There are more than 356,000 out-of-hospital cardiac arrests (OHCA) in the U.S. each year.1 Almost 90% are fatal.1 This is according to the recent report, Heart and Stroke Statistics – 2022 Update, by the American Heart Association (AHA).2

This translates to approximately 1,000 people per day experiencing cardiac arrest in their home (74%), in public (15%) or in a nursing home (11%). A national public health crises, cardiac arrest is a quiet killer. In 50% of known cases, collapse of the patient is not witnessed.1 Outcomes for OHCA are poor. After hospital admittance only 10% of patients survive to be discharged.1

Complications are inevitable for survivors of cardiac arrest. Most patients experience impaired consciousness and cognitive decline.1 Testing in a cohort of 141 survivors of sudden cardiac arrest (SCA) found that 13% had severe cognitive deficits, 15% exhibited anxiety and depression, 28% had post-traumatic stress symptoms and 52% felt severe fatigue.1 After 12 months, up to 22% still had cognitive impairments.1 Caregivers of SCA survivors also suffer. Among 195 caregivers studied, 25% had anxiety and 14% had depression even after a 12-month interval from the event.1

Physicians traditionally approach prevention of cardiovascular disease (CVD) by advocating for better diet and exercise for the patient with type 2 diabetes mellitus (T2DM). This includes lifestyle management which promotes increased physical activity, weight reduction, smoking cessation, elimination or moderation of alcohol consumption and a tailored nutritional plan.In a 2022 statement, the American College of Cardiology supports a more multifaceted plan for adults with T2DM.3 In addition to  lifestyle modifications, they encourage medications such as anti-diabetic meds, antihypertensives and lipid lowering therapies.3 They also recommend CVD imaging, stress tests, coronary artery calcium and LDL-cholesterol evaluations to identify CVD risk in patients.3

Point-of-care tests (POCT) for lipids provide quick data for full lipid profiles including LDL-cholesterol levels.  POCT can be run while the patient is still in the office and does not require a return visit or a long wait for the results. This facilitates the initiation of preventive actions and medications controlling CVD for the patient. A study by the Rio Grande Valley Accountable Care Organization (RGV ACO) utilized the Abbott Cholestech LDX™ POCT for lipids.4 They found increased control of patient’s blood lipids and blood pressure when POCT devices were regularly employed during appointments.4

Lipid-Screening-Keeps-Hearts-Beating

The percentage of RGV ACO patients who achieved control of their lipids increased by 26% from 2012 to 2014.4 With no test ambiguity or long waits, patient compliance with preventive measures decreased per capita costs by 14% based on reduced hospital admissions, readmissions and use of home health care services.4

In a paper published this year in the Journal of the American Medical Association, rates of lipid control among Black and Mexican American adults were significantly lower than those of white patients.8 Additionally, in 2017-2018, rates of lipid control among women lagged behind that of men. 8 Racial disparities among Hispanic, Black and Asian patients exist, with lower survival and recovery from SCA among these individuals.1 The reasons for these disparities are complex and only explained in part by delays in medical care.1 The RGV ACO patients evaluated with POCT were primarily elderly Hispanic individuals.4 Considering the documented success of the RGV ACO study, POCT may be a useful tool in reducing healthcare disparities and improving equity in minority groups and between genders. 

The same or better adherence to medications was the result of another study where POCT was compared to pathology laboratory testing off-site.5 POCT was deemed equal or better than off-site testing for medication adherence. Use of the Cholestech LDX instrument at the point-of-care provided a 1% increase in medication adherence among patients with hyperlipidemia.5

A lipid panel was performed for adult patients with congenital heart disease (CHD), a common birth defect affecting the heart and its functions 6, using a POCT Cholestech LDX analyzer.7  Among the 186 participants, dyslipidemia was found to be highly prevalent despite less than 15% of patients reporting a prior diagnosis of this condition.7 Because dyslipidemia may lead to atherosclerotic disease in this population, the authors suggested regular lipid screening as part of preventive maintenance for adults with CHD. POCT for lipids have been proven to reduce risk factors for both CVD and CHD. Combined with the latest AHA guidelines, POCT may preventively reduce OHCA and health care disparities when labs results are shared with a patient in a timely manner. 

  1. Sudden Cardiac Arrest Foundation, Latest Statistics. https://www.sca-aware.org/about-sudden-cardiac-arrest/latest-statistics
  2. Heart and Stroke Statistics – 2022 Update, by the American Heart Association https://www.ahajournals.org/doi/10.1161/CIR.0000000000001052
  3. Jha, K, Adhikari, R, et al. 2022 AHA Statement on the Comprehensive Management of CV Risk Factors for Adults with T2DM. American College of Cardiology. March 21, 2022. https://www.acc.org/latest-in-cardiology/articles/2022/03/21/16/51/2022-aha-statement-on-the-comprehensive-management-of-cv-risk-factors-for-adults-with-t2dm
  4. Rio Grande Valley Accountable Care Organization Point-Of-Care Case Study – Abbott https://content.veeabb.com/1d09429b-8373-419f-8f1a-d28f9586863a/f5e03762-6ddf-42db-88f0-33d8e4f9eb3e/f5e03762-6ddf-42db-88f0-33d8e4f9eb3e_source__v.pdf
  5. Gialamas, A, Yelland, LN et al. (2009) Does point-of-care testing lead to the same of better adherence to medication? A randomized controlled trail: the PoCT in General Practice Trial.  MJA 91: 487-491. https://staging.mja.com.au/system/files/issues/191_09_021109/gia10573_fm.pdf
  6. CDC What are Congenital Heart Defects? January 24, 2022.  https://www.cdc.gov/ncbddd/heartdefects/facts.html#:~:text=CHDs%20are%20present%20at%20birth,formed%20parts%20of%20the%20heart).
  7. Wu FM, Mendelson ME, et al. (2022) Dyslipidemia among adults with congenital heart disease. JACC: Advances. https://doi.org/10.1016/j.jacadv.2022.100081
  8. Mitchell, J. Disparities Persist in Lipid Control. Harvard Medical School News and Research, Aug. 30, 2022.  https://hms.harvard.edu/news/disparities-persist-lipid-control