A health system–wide lipid screening pathway significantly increased pediatric screening rates across a large primary care network.
Universal lipid screening for children and adolescents improved markedly following implementation of a system-based clinical pathway, according to new findings presented at the 2025 American Heart Association Scientific Sessions.1
Pediatric dyslipidemias are among the most treatable causes of cardiovascular disease (CVD). Early detection of lipid abnormalities allows for timely management to reduce future CVD risk. The National Heart, Lung, and Blood Institute (NHLBI) Expert Panel guidelines, issued in 2011, recommend universal lipid screening for children aged 9 to 11 years and again at 17 to 21 years. Selective screening is advised for younger children beginning at age 2 years if there is a family history of early cardiovascular disease, familial hypercholesterolemia, obesity, hypertension, diabetes, or other risk factors such as chronic kidney disease or inflammatory disorders.2
Despite these recommendations, screening rates remain suboptimal in the United States. According to contemporary estimates, fewer than half of children and adolescents receive lipid screening. To address this gap, researchers from Nemours Children’s Health in Wilmington, Delaware, developed a quality improvement initiative aimed at increasing adherence to screening recommendations within their health system.1
“The SMART aim was to increase lipid screening rates in children and adolescents seen within a primary care network from 36% to 80% within 12 months,” the authors stated.
A multidisciplinary team of preventive cardiologists, primary care leadership, and improvement specialists collaborated across 38 clinics in three states to design and implement a standardized clinical pathway. The pathway included universal lipid panel screening for all eligible patients, targeted screening for those with positive familial hypercholesterolemia questionnaires or risk factors, and clear management guidance for abnormal results. The team employed plan-do-study-act (PDSA) cycles to test and refine interventions and used statistical process control charts to monitor outcomes and identify meaningful variation over time.
During the baseline phase (May 2022–December 2023), 33,496 patients met inclusion criteria. In the intervention phase (January 2024–April 2025), 24,944 patients were evaluated. Following the first 3 interventions, lipid screening improved from 36% to 69%. Preliminary data indicated continued improvement toward the 80% target as the clinical pathway became fully integrated.
Disaggregated results revealed higher improvement in the 9- to 11-year cohort, where screening rates increased from 37% to 75%, compared with 29% to 59% among those aged 17 to 21 years. These findings suggest that embedding guideline-based prompts and standardized workflows in primary care may particularly enhance adherence to early adolescent screening recommendations.
“Quality improvement methodology improved lipid screening rates within a large pediatric primary care network,” the authors concluded. “Health systems may consider multimodal interventions including physician incentivization, electronic health record reminders, physician interviews, and the development of clinical pathways to improve lipid screening in the pediatric population.”
The results underscore the value of health system–wide approaches to preventive cardiology in children. Aligning local clinical pathways with national screening guidelines—such as those from the NHLBI—may bridge long-standing implementation gaps and promote early identification and management of pediatric dyslipidemia.
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