Barrier identification and strategic design for hypertriglyceridemia management in the post-acute coronary syndrome patient population at a large integrated health system.

Objectives: Patients on statin therapy with persistent hypertriglyceridemia (HTG) (TG > 150 mg/dL) post-acute coronary syndrome (ACS) are at increased risk of residual cardiovascular disease (CVD). Despite recommendations to incorporate icosapent ethyl (IPE) to reduce recurrent CV events, HTG care is not standardized. We aimed to 1) co-design a strategy package to improve CV risk management in post-ACS patients with HTG, and 2) assess TG care changes following the pilot. Methods: A pre-implementation survey assessed clinician perspectives of standardizing HTG management. Contextual inquiries informed a deliberative engagement session to co-design implementation strategies. One cardiology clinic piloted the final package. Resource use and electronic health record data were assessed for outcomes and care patterns. Results: Survey responses (N = 16) indicated that a standardized TG management approach is acceptable, appropriate, and feasible. Clinician interviews (N = 7) highlighted lack of priority in HTG care. IPE is favored for CV benefit, but coverage concerns persisted despite established institutional routinization. A strategy package to overcome identified barriers was finalized following deliberative engagement. 50% (20/40) of invited clinicians attended the pilot presentation, and 7.5% used additional resources and workflow strategies. Medication use was consistent among eligible patients, but 1.1% received IPE, limited to severe HTG (>500 mg/dL). Conclusion: Operationalized clinician strategies had varied uptake, and IPE use remained minimal. An educational presentation from experts demonstrated importance of intervention but did not translate to clinician motivation. Findings highlight areas for improvement and inform early development of a standardized clinical pathway to reduce CVD risk in post-ACS patients with HTG.