Rational and design for test 2 treat: A randomized implementation trial to improve LDL-C management after hospitalization for ASCVD

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Background Lowering low-density lipoprotein cholesterol (LDL-C) to guideline-based goals is essential in the management of patients with atherosclerotic cardiovascular disease (ASCVD). Yet, real world evidence indicates that LDL-C is infrequently tested after an ASCVD event, and many patients remain with uncontrolled LDL-C. Methods Test 2 Treat is an implementation study that aims to assess the impact of multifaceted health system and patient-level interventions to improve LDL-C testing and management in patients hospitalized with myocardial infarction (MI) and/or percutaneous coronary revascularization (PCI). The study is divided into two components: one component is a hospital-level implementation intervention based on system specific barriers to improve LDL-C testing and management; and the other component is a patient-level 1:1 randomized controlled trial that tests the impact of a care champion to help coordinate care for patients discharged after a MI and/or PCI compared to usual care. Results Five health systems are included in the hospital-level component and six health systems in the patient level component. A total of 399 patients enrolled in the patient level component from 10/8/2024 to 11/20/2025. Baseline characteristics of those enrolled include a mean age of 63.5 ±11.7 years, 37.8% female, and 16.8% Black/African American. Additionally, 33.4% presented with STEMI, 49.2% with type 1 NSTEMI, and 17.1% PCI without MI. The mean LDL-C across both arms at baseline was 117.6 ± 32.2 mg/dL, and 78.6% were on high intensity statin at discharge. Conclusions Overall, Test 2 Treat aims to discover effective, adaptable, and scalable strategies to reduce LDL-C in high-risk patients.

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