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 the detection of Familial Hypercholesterolaemia (FH) through the use of an innovative child-parent screening programme, rolling out inclisiran and lipid optimisation.
Read more about:
- The revised lipid management pathway
- Child-parent screening for FH
- Lipids optimisation programme – including Rapid Uptake Products
- Tackling Cholesterol Together – a free education programme for primary care
- Using proactive care frameworks for people with long term conditions
Alongside our work on CVD, we are also supporting a national Blood Pressure Optimisation programme. Read more more about this work.
Revised Lipid Management Pathway – launched December 2021
The clinical pathway for lipid management has now been updated 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, supporting the NHS Long Term Plan’s ambitions for cardiovascular disease prevention and to improve patient outcomes.
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.
The Child-Parent Screening programme aims to identify families with Familial Hypercholesterolaemia (FH).
As part of the Child-Parent Screening programme, the West of England AHSN will support GP practices across the region to implement a clinical pathway which will identify children with FH through a simple heel prick blood test, taken at the child’s routine one year immunisation appointment.
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 1 year immunisation visit using a Point of Care heel prick capillary test. Evidence shows that age one is when cholesterol measurement discriminates best between individuals with and without FH and 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. Siblings and second degree relatives can also be counselled, screened and treated as necessary.
Child-parent screening offers an equitable approach to FH identification and can detect up to 90% of affected people. One study found that for every 1,000 children screened, 8 people (4 children and 4 adults) were identified as having FH and could begin potentially lifesaving medication and/or lifestyle and dietary changes.
Where a child is identified as having FH, parents, siblings and grandparents can also be tested as necessary potentially identifying full families who have FH. Age appropriate medication and advice can then be offered to families to reduce the risk of cardiac disease.
CPS national pilot – hear from the frontline and get involved
The Child-Parent Screening (CPS) programme is currently being piloted, initially for 24 months, across seven AHSN regions, including in the West of England. In the West of England we hope to screen circa 3000 children.
Read our blog which hears from Gloucestershire GP Dr Amy Howarth about her practice’s experiences of piloting CPS.
If you work in a practice in the West of England and would like to get involved in CPS, please view our invitation and contact Clare Evans, Deputy Director of Service and System Transformation – firstname.lastname@example.org or Rachel Gibbons, Programme Manager – email@example.com to discuss how we can work with you.
The AHSN Network’s FH and 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’re working with Bristol, North Somerset and South Gloucestershire (BNSSG) CCG, Gloucestershire Hospitals NHS Foundation Trust and five 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.
Read more about our work across BNSSG to optimise lipids, and increase use of PCSK9i therapy for eligible patients.
Cholesterol and lipid disorders webinars: key messages in diagnosis and management – multiple dates to 19 October 2022
The West of England AHSN is providing a series of 1-hour online education sessions for GPs and healthcare professionals on the management of patients with high cholesterol and lipid disorders.
Delivered by secondary care consultants and GPwSI (GPs with Special Interest), this virtual session will include time for questions and discussion.
CVD prevention for practice nurses – multiple dates to 26 July 2022
We’re hosting a series of 60-minute online education sessions for practice nurses on the management of patients at risk of CVD. Delivered by an Advanced Nurse Practitioner, the virtual session will include time for questions and discussion. Although this will be of particular benefit to practice nurses, the sessions are open to all primary care health care professionals.
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.
Inclisiran in primary care: key messages – multiple dates to 19 October 2022
The West of England AHSN is providing a series of 1 hour online education sessions for GPs and Health Care Professionals on the use of Inclisiran to manage patients with high cholesterol and lipid disorders.
If your work is related to CVD and lipids optimisation in the West of England region whether that be as an Integrated Care System lead, in a Trust, Primary Care Network, General Practice, pharmacy or as a local lipid specialist, please get in touch with Clare Evans, firstname.lastname@example.org or Rachel Gibbons, email@example.com.
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 have 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.
Read more about proactive care frameworks, and access free implementation resources.