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.
One of the national AHSN Network’s programmes focuses on Familial Hypercholesterolaemia (FH) detection and lipid optimisation to reduce death and disability due to premature CVD. Read more about the AHSN Network programme.
Read more about:
- The revised lipid management pathway (launched December 2021)
- Child parent screening for FH
- Lipids optimisation programme and 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.
Free lipids webinar – 19 January 2022
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. The pathway can be found here.
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.
Adults identified as having FH will receive statins immediately. Children will be given dietary advice and will be regularly monitored. Statins may then be started around age 10.
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 – 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.
If you are a GP or PCN in the West of England and would like to get involved in this programme please view our invitation and contact Clare Evans, Deputy Director of Service and System Transformation – email@example.com or Rachel Gibbons, Senior Project Manager – firstname.lastname@example.org 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 AAC Rapid Uptake Products (RUP) lipid programme which focuses on: High Intensity Statins, Ezetimibe and PCSK9 inhibitors. Read more about RUP.
We supported NHS organisations to apply for funding through phase three of the Pathway Transformation Fund to increase the adoption and spread of RUP. Four applications were successful in our region including the following:
- Gloucestershire CCG and Gloucestershire Hospitals NHS Foundation Trust – Lipid Optimisation. Working with five GP practices we will use search options within practice databases to identify patients at risk of raised cholesterol who would benefit from a detailed medication review.
How a heart attack saved a young mum’s life
In the latest Health Innovation Podcast from the AHSN Network, we speak to a fit and healthy 34-year-old mum who discusses how she had a heart attack while pregnant due to the genetic condition Familial Hypercholesterolaemia (FH), which creates an abnormal level of cholesterol in the blood. Our guest, Clara, talks to Dr Phil Jennings, AHSN Network Lead for the Rapid Uptake Products.
Listen to the Health Innovation Podcast now on Audioboom.
Inclisiran – and how to get involved
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. Now that Inclisiran is available to NHS patients in England, AHSNs, as the delivery partner, are working to ensure that the new treatment fits seamlessly within the lipids care pathway.
Inclisiran webinars – 26 January to 10 March 2022
The West of England AHSN is providing a series of 1-hour online education sessions (which will be repeated on three dates) for GPs and Health Care Professionals on the use of Inclisiran to manage patients with high cholesterol and lipid disorders.
Delivered by secondary care consultants and pharmacists, this virtual session will cover:
- What is PCSK9?
- What is Inclisiran and how does it work?
- Evidence base and safety data
- Practical issues in prescribing and administration
- Questions and discussion
Inclisiran – get involved
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, email@example.com or Rachel Gibbons, firstname.lastname@example.org so we can discuss how Inclisiran can be adopted by your organisation.
Tackling Cholesterol Together – a free education programme for primary care
Led by key national figures in cardiovascular disease, Tackling Cholesterol Together is the national professional education programme supporting the NHS England and NHS Improvement (NHSEI) 3-year lipids workstream.
The programme will support healthcare professionals to address under diagnosis and under treatment at scale and use new models to manage cholesterol, underpinned by an updated NICE endorsed pathway, with certificates issued for completion of all content.
Tackling Cholesterol Together will be delivered though videos, podcasts, webinars, expert clinics and online modules. Topics covered range from statin intolerance to behavioural change, Familial Hypercholesterolaemia (FH), novel therapies on the horizon, and much more.
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 are piloting 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 our work on proactive care frameworks, and access our free implementation resources.