Measured, Practical Approaches to Reduce Cardiovascular Risk for Adults with Type 2 Diabetes Yields Improvements

Alexandria, VA – The Together 2 Goal® Innovator Track Cardiovascular Disease Cohort (CVD Cohort), an AMGA quality improvement initiative, has identified strategies for measurably reducing CVD risk in patients with Type 2 diabetes. More than 30 million Americans—nearly 10% of the U.S. population—have diabetes. Most people with diabetes have Type 2 Diabetes, and adults with Type 2 Diabetes are about twice as likely to die from heart disease as adults who do not have diabetes, according to an HHS report.

• The 12 medical groups and health systems participating in this yearlong initiative identified and implemented a number of interventions with the goal of lowering CVD risk in Type 2 diabetes patients. The goals of these interventions fell into three categories:
• Educate provider on the link between diabetes and CVD
• Enhance EHR use to identify and better manage CVD risk
• Improve processes and workflows to ensure CVD risk is addressed

To measure the effectiveness of these interventions, participants submitted baseline and quarterly data on six measures selected by the initiative’s advisory committee. These measures were selected for their relevance to CVD risk, according to guidelines from the American Diabetes Association, the American College of Cardiology, and the American Heart Association. The measures included smoking cessation, lipid management, and appropriate regimentation of high intensity statin and daily aspirin.

As a whole, participants saw improvement in each of the six measures. Of these, the greatest improvement was in lipid management to prevent secondary cardiovascular events, as 1,640 additional patients achieved the goal value for LDL cholesterol level (i.e., less than 70 mg/dL) during the initiative. Participants with the most improvement in lipid management attributed their success to identifying patients who were not on a statin or were on the incorrect dose of statin and moving them to the guideline-recommended statin.

The second highest rate of improvement was in the category of high intensity statin regimentation, in which 2,000 patients were moved to the right statin for reducing CVD risk based on recommended guidelines. Participants with the most improvement in statin regimentation attributed their success to changes in workflow and EHR use.

Additionally, nearly 1,700 patients achieved tobacco-free status during the yearlong initiative. Participants with the most improvement in smoking cessation attributed their success to use of smartphone apps.

The chart below shows the average rate of improvement for each of the six measures. Although daily aspirin for primary prevention was tracked during the Cohort, it was not an ongoing focus due to the evidence released in late 2018 about the risks of daily aspirin for people without atherosclerotic CVD (ASCVD).

Measure Key:

• Proportion of Type 2 diabetes patients (ages 18 - 75) reporting a tobacco-free status (Tobacco Free)
• Proportion of Type 2 diabetes patients (ages 18 - 75) with a history of ASCVD:
  • On daily aspirin, also called “Daily Aspirin for Secondary Prevention” (Aspirin: Secondary Prevention)
  • On any statin (Any Statin)
  • On a high-intensity statin (High-Intensity Statin)
  • With a measured LDL cholesterol level equal to or lower than 70 (LDL < 70)
• Groups monitored the proportion of patients age ≥ 50 with no ASCVD history who were on daily aspirin (Aspirin: Primary Prevention). Aspirin for primary prevention was not an area of focus during the Cohort due to the conflicting literature that was published during the program

“People with Type 2 diabetes face a significant risk of developing and even dying from CVD, so being able to identify approaches that can ultimately prevent or reduce cardiovascular events for these patients is a crucial step to improving their care,” said John Kennedy, M.D., AMGA Foundation president and AMGA chief medical officer. “Since there isn’t a large body of knowledge on CVD risk reduction in patients with type 2 diabetes, we look forward to sharing the newly developed CVD Cohort case studies and other helpful information about reducing CVD risk as the Together 2 Goal® campaign continues through March 2021.”

Although the CVD Cohort has concluded, nearly all of the participating groups plan to continue tracking the main measures selected during the Cohort (e.g., daily aspirin and high-intensity statin for secondary prevention). Many groups also plan to bring their approach into closer alignment with the latest evidence-based guidelines from leading organizations like AACE/ACE, ACC, ADA, AHA, and EASD, as these groups have taken strong action to prioritize CVD risk in the adult population with Type 2 diabetes through guideline changes related to care management as well as treatment recommendations.

Case studies detailing interventions implemented by the participating groups during the CVD Cohort are available on the Together 2 Goal website.

The CVD Cohort was sponsored by the Boehringer Ingelheim and Lilly Diabetes Alliance.

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About the Together 2 Goal® Campaign
AMGA Foundation, the philanthropic arm of AMGA, launched Together 2 Goal®, a five-year national campaign to fight the challenge of Type 2 diabetes on March 12, 2016. Together 2 Goal® includes more than 150 medical groups, health systems, non-profit partners, and corporate collaborators such as the American Diabetes Association, American Association of Diabetes Educators, Janssen Pharmaceutical Companies of Johnson & Johnson, Novo Nordisk, Optum, Boehringer Ingelheim and Eli Lilly and Company, and Merck. The goal of the five-year campaign is to improve care for 1 million people with Type 2 diabetes by 2021.

About the Innovator Track Cardiovascular Disease Cohort
The Together 2 Goal® Innovator Track Cardiovascular Disease Cohort (CVD Cohort) is a national program designed for medical groups and health systems to explore how providers can better identify and manage CVD risk among their patients with Type 2 diabetes. The program is sponsored by the Boehringer Ingelheim and Lilly Diabetes Alliance. AMGA selected a national Advisory Committee comprised of five experts—including medical directors, a pharmacist, and a cardiologist—to lead the year-long program by selecting the data measures to be tracked and serving as mentors for participating groups. In collaboration with the Advisory Committee and AMGA staff, groups developed and implemented action plans aimed at reducing CVD risk for patients with type 2 diabetes. Participants include:

About AMGA Foundation
AMGA Foundation is AMGA’s philanthropic arm that enables medical groups and other organized systems of care to consistently improve health and health care. AMGA Foundation serves as a catalyst, connector and collaborator for translating the evidence of what works best in improving health and health care in everyday practice. 

About AMGA
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.