Abstract 4351564: Primary Results of the VICTORION-NOVEL (LDL-C maNagement PrOgram in Atherosclerotic Cardiovascular Disease (ASCVD) patients with Elevated LDL-C) Lipid Optimization Multicenter Implementation Trial

Abstract

Background: Most patients with atherosclerotic cardiovascular disease (ASCVD) do not advance beyond statin therapy and do not achieve the recommended low-density-lipoprotein cholesterol (LDL-C) thresholds. Gamification between peer clinicians may boost performance in lipid management. Research Question: Can a multifaceted gamified intervention, including a live performance dashboard, peer-to-peer discussions, and clinician and patient engagement materials improve LDL-C optimization in patients with ASCVD? Methods: VICTORION-NOVEL was a US prospective, multicenter implementation trial including 66 clinicians across ambulatory practices at 6 sites (3 intervention and 3 control) between September 2023 to August 2024. Adults ≥18 years with established ASCVD, statin therapy and LDL-C ≥ 70 mg/dL were included. Primary outcome was the probability of experiencing a composite endpoint, defined as 1) achieving LDL-C < 70 mg/dL, 2) achieving ≥ 20% reduction in LDL-C, or 3) experiencing intensification of lipid lowering therapy (LLT) within 1 year. Extended Cox regression model was used to assess time to earliest composite endpoint, adjusting for confounders. Results: Overall, 1,097 patients (364 intervention, 733 control) were included (mean age 68, 45% women). While age and sex distributions were balanced, patients in the control arm were more likely to be White (89% vs. 79%), non-Hispanic (97% vs. 67%) and less likely to have hypertension (47% vs. 81%) and atrial fibrillation (2% vs. 20%). A significant time-varying effect on the primary endpoint was observed during the 1-year follow-up, with potentially late beneficial effects emerging after the second peer-to-peer call (adjusted HR 1.34; 95% CI 1.07-1.68). At 1-year, a higher proportion of intervention patients achieved LDL-C<70 mg/dL than control patients (23% vs. 16% p<.01), while similar proportions of patients achieved 20% reduction in LDL-C (30% vs. 32%) and had intensification of LLT (17% vs. 22%). The comparative data dashboard, which allowed providers to assess and compare their own patients’ outcomes to the outcomes of their colleagues’ patients, was reported as a helpful tool. Conclusions: While the implementation of a gamified, multifaceted intervention did not significantly improve overall lipid optimization at 1-year, it was associated with a higher proportion of patients achieving LDL-C goals. The delayed emergence of benefit suggests that a lead-in period may be required for full effectiveness.