A meds-to-beds program implemented at New York City-based Montefiore Health System improved low-density lipoprotein cholesterol in patients undergoing coronary or peripheral artery revascularization, according to a study published Aug. 21 in JACC: Advances.
The improved LDL-C levels remained among patients who participated in the program at six months post-revascularization.
Montefiore’s meds-to-beds program identified eligible patients and prescribed guideline-recommended proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies to be delivered to the patient’s bedside or home.
PCSK9 inhibitors have proven effective for the secondary prevention of atherosclerotic cardiovascular disease among patients undergoing revascularization, but adherence remains limited, according to the study.
Leandro Slipczuk, MD, PhD, section head of clinical cardiology, director of advanced cardiac imaging and the CV Atherosclerosis and Lipid Disorder Center at Montefiore, and an author of the study, shared more about the clinical implications of this research with Becker’s.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What prompted Montefiore to launch this initiative? What challenge were you trying to solve with a meds-to-beds approach?
Dr. Leandro Slipczuk: The program was first developed to ensure timely initiation of guideline-directed dual antiplatelet therapy at the time of percutaneous coronary intervention. It later expanded to address the persistent problem of inadequate low density lipoprotein cholesterol control in secondary prevention patients undergoing atherosclerotic cardiovascular disease revascularization. The meds-to-beds framework was designed to overcome therapeutic inertia, limited access to therapy, insurance authorization barriers and early non-adherence by enabling in-hospital initiation and immediate post-discharge continuity of care.
Q: Did starting therapy before patients left the hospital help with adherence and follow-up engagement?
LS: Initiating therapy in the hospital improved adherence and follow-up engagement, particularly for a self-injected medication such as a PCSK9 inhibitor. Bedside initiation allowed the care team to provide education on administration, safety and storage, which facilitated patient confidence and continued use. Adherence was assessed during routine post-discharge clinical visits and structured telephone interviews conducted by the cardiology team, and reinforced by follow-up LDL-C measurements to confirm therapeutic effect.
Q: How does this program differ from other meds-to-beds efforts? What made it uniquely effective in improving access and adherence for high-risk cardiovascular patients?
LS: This approach combined opportunistic screening for LDL-C goal attainment at the time of revascularization with systematic in-hospital initiation of therapy and close post-discharge follow-up. Integration of primary care physicians and cardiologists into follow-up ensured coordinated monitoring and timely laboratory testing. The twice-a-month dosing schedule of the prescribed PCSK9 inhibitor is standard, but the program bridged the gap of care to start guideline-directed PCSK9 inhibitors.
Q: What role did the pharmacy team play in making the program successful? How did you align them with cardiology and care teams?
LS: Pharmacists and dedicated liaisons facilitated insurance authorization, provided discount coupons to eligible patients and coordinated bedside and home delivery to ensure uninterrupted access to therapy. Nurses delivered patient education on injection technique, safety and storage, while the cardiology team coordinated overall care and performed follow-up telephone interviews, creating a seamless transition from inpatient to outpatient management.
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