Collaborative approach shows promise for lipid optimisation

Problem

Cardiovascular disease (CVD) accounts for significant mortality. In Staffordshire, avoidable premature CVD death in under 75’s is almost double the England average. Lipid optimisation is an unmet clinical need: CVDPrevent data highlights variations in lipid optimisation across Staffordshire, with the proportion of patients meeting secondary prevention lipid targets varying between 13-50% across GP practices (June 2023). Moreover, lipid pathways in hospital after a CVD event were not standardised. Cardiology patients benefit from lipid optimisation in cardiac rehabilitation, but there is no established pathway for cerebrovascular disease or peripheral arterial disease patients.

Intervention

Working with specialist clinics, primary care clinicians, health leaders and hospital management, supported by a 12-month HIWM/NHSE Collaborative Lipid Fund, a new service was established. The aims were to identify and optimise lipids in eligible patients, establish cross-sector links, educate clinicians, and develop future pathways.

A pharmacist-led screening to identify patients with established CVD and hyperlipidaemia (LDL-cholesterol >2.0mmol/L) from stroke/TIA and vascular claudication clinics was implemented. Weekly multi-disciplinary team (MDT) sessions and a newly established joint clinic with a lipid consultant offered lipid optimisation for eligible patients using NHS England Accelerated Access Collaborative (AAC) guidelines. Lipid lowering therapies included high intensity statins, non-statin oral medications, and injectable therapies. 

Links were established with primary care clinicians to deliver education sessions, develop a lipid management pathway, and foster cross-sector working opportunities.

Effects of changes

Of the 537 patients screened, 86 (16%) required optimisation and a further 88 (16.4%) required blood tests to determine eligibility. These patients are undergoing lipid optimisation.

In patients eligible for optimisation, the average baseline of non-HDL cholesterol was 4.0mmol/L (range 2.7-13.9mmol/L), and LDL-cholesterol 3.0mmol/L (range 2.1-5.2mmol/L), both above NICE recommended targets (≤2.6mmol/L and ≤2.0mmol/L respectively).

Preliminary outcome data has demonstrated a reduction in average non-HDL cholesterol to 2.7mmol/L (range 1.2-5.2mmol/L) and average LDL-cholesterol to 1.9mmol/L (range 0.3-4.3mmol/L). 

Well-received GP/pharmacist educational sessions were attended by over 200 primary care professionals. An advice and guidance portal was developed, and a pharmacist-led cross-sector MDT established to support primary care professionals. New local lipid management pathway documents are being developed. 

Conclusions

Interim data shows the benefit of a collaborative approach in early detection and appropriate lipid optimisation. We screened and identified high risk patients from specialist clinics, optimised lipid lowering therapies, established new links and provided educational sessions. This model, involving clinicians from primary and secondary care specialist clinics, has the potential to address lipid optimisation on a large scale across a region with significant health inequalities.

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.