Cardiovascular disease risk and Lung cancer screening for Early Assessment of Risk (project CLEAR) in Missouri: A protocol for a mixed methods study

BackgroundLung cancer and atherosclerotic cardiovascular disease (ASCVD) are leading causes of mortality in the United States, sharing common risk factors like smoking and age. Preventive care for these conditions is often siloed, leading to missed opportunities to prevent ASCVD-related mortality in lung cancer screening (LCS) patients. In various trial settings, patients undergoing LCS were more likely to die from ASCVD than from cancer; however, less than half of eligible patients got statin prescription. This study aims to understand the degree to which ASCVD risk assessment and prevention is done in routine "real-world" clinical settings providing LCS in Missouri. Our objectives are to determine the prevalence of statin eligibility, statin prescription and explore factors, disparities and barriers to statin therapy in people undergoing LCS. MethodsA parallel convergent mixed-methods design will be used. Quantitative data from people undergoing LCS at Barnes-Jewish Healthcare System will be extracted from Epic electronic medical records (EMR) from January 2022-December 2023, capturing demographics, socioeconomic factors, and clinical data including ASCVD risk factors and statin use. We anticipate gathering about records for approximately 8,000 patients. Qualitative data will be gathered from in-depth interviews with up to 15 healthcare providers to identify barriers, facilitators and recommendations for enhancing statin therapy in people undergoing LCS. DiscussionThe risk of mortality is drastically heightened in people undergoing LCS who are not receiving statin therapy, and thus there is an urgent need to identify those who are eligible but not receiving ASCVD prevention. Promoting ASCVD risk assessment and prevention in LCS programs has the potential to mitigate the dual burden of ASCVD and lung cancer in high-risk populations who smoke cigarettes. This study will demonstrate the extent of the gap in statin therapy among LCS and provide insights into disparities, barriers and recommendations for integrating ASCVD risk assessment and prevention with LCS. ConclusionThis study will provide real-world baseline data on statin therapy among people undergoing LCS in Missouri, and will highlight disparities, barriers and recommendations for integrating ASCVD prevention in LCS.