Advancing Emergency Cardiovascular Care Research

Summary

High cholesterol (also called hyperlipidemia or HLD) is a major cause of cardiovascular disease. Nearly 1 in 3 people who come to the emergency department (ED) with chest pain have high cholesterol that has not yet been diagnosed or treated.¹ Having high cholesterol puts one at greater risk for atherosclerotic cardiovascular disease (ASCVD).² Although there are safe and effective treatments for high cholesterol, the ED usually focuses on acute care and does not offer preventive health services. This means many patients miss a chance to get the care they need, with only 30% of patients receiving outpatient follow-up care within 30 days of their ED visit.¹ This study will test whether starting preventive care for ASCVD in the ED can help lower cholesterol and heart disease risk. It will also look at how well patients follow treatment plans and what factors affect how this kind of care is delivered in the ED.

This study explores a new approach to managing HLD in ED patients at risk for ASCVD. Dr. Nicklaus Powell Ashburn, MD, MS, and his team designed an intervention to compare a new ED-based care model called EMERALD (Emergency Medicine Cardiovascular Risk Assessment for Lipid Disorders) with standard care. This care model intervention involves a trial with 130 patients aged 40 to 75 years, who have prior ASCVD, known diabetes, or a 10-year risk of heart disease or stroke, and are not already receiving guideline-directed outpatient preventive care.¹ Participants are randomly assigned to either the EMERALD program, which includes lipid screening, lifestyle counseling, statin therapy, and referrals to preventive care, or usual care, which includes primary care referral without an ED statin prescription. The primary outcome is the percent change in low-density lipoprotein cholesterol (LDL-C) at 30 days. The goal is to find out if EMERALD can lower LDL-C more effectively than usual care. If successful, this approach could be an important step toward reducing serious health problems and deaths linked to high cholesterol.

Significance

The EMERALD intervention addresses a gap in care for patients who visit the ED with chest pain and have undiagnosed or untreated cardiovascular risk factors. By introducing lipid screening, statin therapy, lifestyle counseling, and referrals to preventive cardiovascular care, EMERALD has the potential to improve early detection and management of high cholesterol while also reducing the risk of cardiovascular disease. This approach could lead to patients having better long-term heart health and reduced future emergency visits. Patients at risk for cardiovascular disease—especially those who may not receive regular outpatient care—stand to benefit most from this model, along with healthcare systems seeking more efficient ways to deliver preventive services.

The EMERALD intervention helps close a critical gap in care for patients who visit the ED with chest pain and have undiagnosed or untreated cardiovascular risk. Many of these patients, especially those from underserved communities, lack access to regular preventive care. By offering cholesterol screening, statin therapy, lifestyle counseling, and referrals during ED visits, EMERALD reaches individuals who might otherwise go untreated. This approach promotes early intervention and supports long-term heart health, helping reduce disparities in cardiovascular outcomes and improving access to preventive care for populations that have historically been overlooked.

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

Clinical & medical benefits

Provides evidence for development of ED guidelines when treating HLD patients. potential.

Guidelines

Primary beneficiary:

Clinicians

Implemented cholesterol-lowering intervention to reduce cardiovascular risk and improve long-term patient outcomes. demonstrated.

Therapeutic procedures

Primary beneficiary:

Patients

Community & public health benefits

Implemented a care delivery model that integrates preventive cholesterol management into the ED workflow, unlike usual care. demonstrated.

Health care delivery

Primary beneficiary:

Clinicians

Reduced atherosclerotic cardiovascular disease risk (ASVCD). potential.

Disease prevention & reduction

Primary beneficiary:

Patients

This research has clinical and community implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.³

Clinical

The EMERALD intervention demonstrates meaningful clinical impact by introducing guideline‑directed cholesterol management directly into the emergency department—an environment where preventive care for hyperlipidemia is rarely initiated. Through the Wake Forest CTSI Ignition Award pilot, the research team showed that ED‑initiated preventive care can successfully engage patients who often do not have access to routine primary care. In the preliminary CTSI Ignition Award cohort, 94% of participants filled their statin prescription within 10 days, and 75% completed LDL‑C testing at 30 days, with a 19.5% average reduction in LDL‑C levels. These early results demonstrate the feasibility and efficacy of initiating lipid‑lowering therapy during the ED visit and provide essential evidence supporting the integration of preventive cardiovascular care into emergency medicine workflows.

Community

The EMERALD intervention provides community‑level benefits by addressing a persistent prevention gap among individuals who seek emergency care for chest pain but lack consistent access to outpatient cardiovascular risk management. By embedding cholesterol screening, statin initiation, and referral mechanisms within the ED, the program reaches patient populations—particularly underserved and historically under‑screened groups—who experience high rates of undiagnosed or untreated hyperlipidemia. If scaled, this approach could reduce future cardiac events, decrease repeat emergency visits, and strengthen preventive care access across the broader community served by the health system.

Lessons Learned

The Wake Forest CTSI Ignition Award enabled Dr. Ashburn and his team to quickly test and evaluate the EMERALD intervention on a smaller patient cohort from the Atrium Health Wake Forest Baptist ED. This initial testing phase was essential in securing Dr. Ashburnʼs NIH/NHLBI K23 funding, as the preliminary data collected through the Wake Forest CTSI Ignition Award were highly regarded by reviewers. Together, these funding mechanisms catalyzed collaboration across multiple departments—including Emergency Medicine, Cardiovascular Medicine, Family and Community Medicine, Biostatistics and Data Science, Implementation Science, and Social Sciences and Health Policy. This interdisciplinary synergy laid the foundation for a comprehensive and effective approach to improving patient care.