The Penn Medicine Healthy Heart Program

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in the United States and worldwide. A few factors contribute to the problem of ASCVD risk: poor uptake and adherence to medications, persistently unhealthy behaviors, and a system incentivized to treat rather than prevent.   

With support from the NIH Clinical and Translational Science Award and institutional support from Penn Medicine, Penn Medicine Healthy Heart is a 6-month program for the reduction of hypertension and hypercholesterolemia grounded in behavioral economics insights to increase uptake of and adherence to evidence-based interventions to reduce ASCVD risk. This text-based program is being offered to approximately 2,000 Penn Medicine primary care patients in West and Southwest Philadelphia and Lancaster County in 2024 as part of a clinical trial to evaluate its effectiveness. The goal is to help patients take action to reduce their heart disease risk by lowering their blood pressure and cholesterol from home while providing additional resources to our busy primary care providers. 

Penn Medicine Healthy Heart emphasizes proactive outreach and prevention outside of a traditional visit model using data assets to identify and risk stratify patients. The program offers blood pressure monitoring and management, cholesterol counseling and medications, healthy eating resources including a custom video series on heart healthy eating, and smoking treatment to patients via text, phone, and video.

The program also aims to relieve overburdened primary care providers through automated hovering technology coupled with a centralized, leveraged team of non-clinical navigators and nurse practitioners.

Penn Medicine Healthy Heart has been developed over two years through over 15 pilot projects across Penn Medicine supported by ASCVD Risk Reduction Initiative. One pilot study found that using automatic referrals to pharmacy services for statins can drastically increase statin prescription rates for patients who would benefit from them. Researchers found that the odds of prescribing the appropriate dose of statins increased sixfold when automated referrals were made to pharmacy services, instead of relying on doctors to assess a patient’s cardiovascular risk and determine whether a statin is needed and at what dose – a process that physicians may not have adequate time for during a patient’s visit.

In a cluster randomized trial, eligible patients in the intervention arm were automatically referred to a centralized pharmacy service, where pharmacists contacted the patients, discussed the use of statins, and initiated therapy when appropriate. There were 1,950 patients in the trial and 975 were assigned to the intervention arm. The researchers discovered that around 86% of the eligible patients were not prescribed statins at baseline, and the others were receiving a dose that was too low. In the intervention arm, there was a significant boost in statin prescription rates – 31.6% were prescribed a statin compared with around 15% in the usual care group. The researchers also found that nearly 25% of the patients in the intervention arm were prescribed a statin at the guideline-recommended dose during the study period compared with 7.7% of patients in the usual care group.

Read coverage of this program’s work below.