The NHS Long Term Plan states that the biggest area where the NHS can save lives over the next 10 years is in reducing the incidence of cardiovascular disease (CVD). CVD causes a quarter of all deaths in the UK and is the largest cause of premature mortality in deprived areas. As part of the Rapid Uptake Products programme the West of England AHSN, along with University Hospitals Bristol and Weston NHS Foundation Trust, successfully applied for Pathway Transformation Funding in 2021 to run an innovative pilot project supporting the implementation of a novel, NICE-approved lipid management clinical pathway. Using the pathway, the pilot identified 444 patients eligible for medication reviews, and of those 7 were referred to secondary care for PCSK9i therapy. The pilot was successful in ensuring hundreds of patients across the region were taking the most effective CVD medication.
To improve a person’s lipid profile, the pathway aims to reduce cholesterol concentration in blood by treating patients with the right medicine. It includes three medicines: High Intensity Statins (HIST), Ezetimibe, and PCSK9 inhibitors. The pathway has since been updated to also include Inclisiran and Bempedoic Acid.
Ten practices across Bristol, North Somerset and South Gloucestershire (BNSSG) participated in the pilot using a cardiovascular disease (CVD) search tool developed and run by One Care. A total patient population of 149,280 was assessed with the CVD tool identifying suitable patients and presenting data alongside recent cholesterol results and current lipid treatment. This data was then further stratified by NICE criteria for PCSK9i therapy in order to case find eligible patients. PCSK9 inhibitors are for the treatment of very high cholesterol and are used together with a statin-type cholesterol-lowering medicine, or for patients who are unable to take or tolerate a statin.
Dr Paula Rostek, GP with Special Interest in CVD, led the project and over the course of 12 months practices were supported to run the searches to identify patients with existing CVD whose lipid levels remained elevated. A designated health care professional in each practice reviewed identified patients using agreed protocols with medications adjusted in line with the NICE-approved clinical pathway. Where a patients’ lipid level remained above target a referral was made to secondary care for consideration of treatment using PCSK9 inhibitors.
615 patients were identified by the CVD tool as possibly eligible for PCSK9i. On review 444 patients were found to be eligible for medication review and as a result 7 patients were referred to the lipid service for PCSK9i therapy.
Teaching was successfully delivered on lipid management, optimisation and secondary prevention. Formal feedback on the teaching session was obtained, and over 90% of respondents felt the teaching was relevant to their clinical practice and additionally, that their clinical practice would change as a result.
Clare Evans, Deputy Director of Service and System Transformation and Head of Adoption & Spread said:
“As a result of this project a sustainable pathway has been developed for BNSSG to optimise the lipid management of high-risk patients in primary care. The findings are relevant for other ICS areas in the West of England and the learning has been shared. This work will support primary care to provide a standardised, evidence-based approach to manage those with established cardiovascular disease. Delivered alongside the pressures of the pandemic, the work of the project team and the participating practices is to be commended.”
To read more about our work on cardiovascular disease and lipids optimisation, visit our webpages.
Posted on April 29, 2022