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.
To reduce death and disability due to premature CVD we’re focusing on a range of projects. Read more about:
- The lipid management pathway
- Child-parent screening for Familial Hypercholesterolaemia (FH)
- Lipids optimisation– through Rapid Uptake Products
- Blood Pressure Optimisation
- Tackling Cholesterol Together – a free education programme for primary care
- Using proactive care frameworks for people with long term conditions
Lipid Management Pathway
The clinical pathway for lipid management was updated in December 2021 to include bempedoic acid to primary prevention and inclisiran into the secondary prevention pathway. This pathway unifies multiple NICE guidance and technology appraisals into a single document to support clinical decision making on lipid management.
Child-parent screening for FH
Familial Hypercholesterolaemia (FH) is an inherited condition passed down through families which can lead to extremely high cholesterol levels. It affects 1 in 250 people in the UK, yet over 90% of cases are still undiagnosed.
Without treatment, FH can lead to heart disease at a young age. Identifying affected individuals before the onset of disease is important because treatments can be put in place that promotes a healthy, active life and lowers blood cholesterol levels, all of which substantially reduce the risk of heart disease.
What does child-parent screening involve?
Child-parent screening offers a population wide, low-cost solution to the management of CVD and is currently the best model for FH detection.
With parental consent, a child is tested for FH at their routine one-year immunisation appointment using a heel prick capillary test. Evidence shows that age one is when cholesterol measurement discriminates best between individuals with and without FH, so screening new-borns or adults is less effective. A small blood sample is taken and from this total cholesterol can be measured.
In those children with a reading of >95 percentile, further genetic testing can be undertaken. If the child receives a diagnosis of FH, at least one of the parents will also be positive, so testing is undertaken. Siblings and second degree relatives can also be counselled and screened. Age appropriate medication and advice can then be offered to families to reduce the risk of cardiac disease.
In the West of England we hope to screen circa 3000 children for FH by March 2023.
Free e-learning: Management of Familial Hypercholesterolemia in General Practice
The Royal College of GPs has recently launched a short ‘Management of Familial Hypercholesterolemia in General Practice’ course, designed to enable primary care health care professionals to better identify, and understand the causes of, FH in patients. This e-learning course will take approximately 45 minutes to complete.
Programme webinar and blog
Read our blog which hears from Gloucestershire GP, Dr Amy Howarth about her practice’s experiences of piloting the screening programme.
Find out more about the programme in a webinar hosted by North East, North Cumbria AHSN:
FH – a patient’s story
Leanne has been diagnosed with Familial Hypercholesterolaemia which has also led to several of her family members also being diagnosed with FH. Hear her story and how she manages her genetic condition in this short video from North East & North Cumbria AHSN:
If you work in a practice in the West of England and would like to get involved, please contact Rachel Gibbons, Programme Manager – email@example.com or Clare Evans, Deputy Director of Service and System Transformation – firstname.lastname@example.org.
The AHSN Network’s lipids optimisation programme is part of a package of work delivered in partnership with the 21/22 Rapid Uptake Products (RUP) programme which focuses on: High Intensity Statins, Ezetimibe and PCSK9 inhibitors.
We’ve worked with Bristol, North Somerset and South Gloucestershire (BNSSG) Integrated Care Board and local GP practices to use search options within practice databases to identify patients at risk of raised cholesterol who would benefit from a detailed medication review. 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. Read more about our work across BNSSG to optimise lipids, and increase use of PCSK9i therapy for eligible patients.
Before now if a patient was on the maximum dosage of statins, had been prescribed Rapid Uptake Products such as ezetimibe or PCSK9i and their cholesterol levels were not decreasing, options were limited. But now inclisiran can support these patients. Inclisiran was made accessible to patients through the first NHS ‘population health agreement’.
Inclisiran injections use a biological process where molecules can shut down protein translation to help the liver remove harmful low density lipoprotein cholesterol (which are often simply referred to as ‘bad cholesterol’) from the blood. Inclisiran can be used with statins or on its own. Read NICE guidance on the use of inclisiran.
The Accelerated Access Collaborative are responsible for the implementation of the inclisiran partnership. AHSNs are working to ensure that the new treatment fits seamlessly within the updated lipids care pathway.
If you’re a healthcare professional, you can read summary information on the supply and funding of inclisiran from NHS England.
Uptake of inclisiran is above average in the West of England, and we are looking to work with more practices to drive adoption and spread.
If your work is related to CVD and lipids optimisation in the West of England region please get in touch with Clare Evans, email@example.com or Rachel Gibbons, firstname.lastname@example.org to discuss how we can work with you and your team.
Tackling Cholesterol Together – a free education programme for primary care
Tackling Cholesterol Together is a professional education programme to support healthcare professionals to address under diagnosis and under treatment at scale and use new models to manage cholesterol – all underpinned by the updated NICE endorsed pathway.
Tackling Cholesterol Together will be delivered though videos, podcasts, webinars, expert clinics and online modules. For more information and access to content please visit Tackling Cholesterol Together.
Using Proactive Care Frameworks
To support the case finding of primary care patients with long term conditions, we piloted a package of tools and resources designed by UCL Partners to enable practice teams to continue to effectively manage patients during and post-COVID-19.
Frameworks focus on the management of atrial fibrillation; high blood pressure; high cholesterol; type 2 diabetes; asthma and COPD.
We are currently delivering a blood pressure optimisation programme, using the UCL Partner framework for hypertension, to prevent heart attacks, strokes, and vascular dementia in patients with high blood pressure.
Read more about proactive care frameworks, and access free implementation resources.