A key part of our work until 2023 will be improving the management of cholesterol. Good management of cholesterol is important in preventing heart attacks and strokes, but patients with high cholesterol are likely to be asymptomatic.
The clinical pathway for lipid management now includes bempedoic acid within primary prevention and inclisiran in 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.
We are always looking for PCNs and GP practices who need our support to help implement the lipids pathway, please contact Julia.reynolds@innovationagencynwc.nhs.uk to explore this further
Tackling Cholesterol Together - education programme
The Innovation Agency is part of a collaboration led by the NHS Accelerated Access Collaborative (AAC), the AHSN Network and cholesterol charity, HEART UK, to deliver an education programme for healthcare professionals around cholesterol.
Tackling Cholesterol Together supports the NHS England and NHS Improvement (NHSEI) three-year lipids workstream, to raise awareness that Cardiovascular Disease (CVD) is preventable yet currently kills 136,00 people every year.
The programme supports healthcare professionals to address under diagnosis and under treatment at scale; and use new models to manage cholesterol, using an updated NICE-endorsed pathway, with certificates issued for completion of all content.
Tackling Cholesterol Together is delivered though videos, podcasts and online modules. Topics covered range from statin intolerance to behavioural change, Familial Hypercholesterolaemia (FH), novel therapies on the horizon, and much more.
Familial hypercholesterolemia
We are supporting national ambitions to improve cholesterol management and the identification and management of familial hypercholesterolemia (FH), a hereditary condition of high cholesterol that is evident from birth but is rarely picked up before the individual has a CVD event.
Parent-child screening for familial hypercholesterolemia
The Innovation Agency is one of seven AHSNs taking part in a national parent-child screening programme to detect familial hypercholesterolemia. Infants will be offered a heel prick at their appointment to be tested at the surgery for elevated cholesterol. If high cholesterol levels are detected the sample will be sent to the regional genomics hub for genetic testing. If familial hypercholesterolemia is identified the family can receive genetic counselling and be registered as having the condition and offered treatment.
Surgeries in the North West Coast have begun this screening programme.
GP practices wishing to join the pilot are welcome to contact Dr Julia Reynolds, associate director of transformation, at the Innovation Agency Julia.reynolds@innovationagencynwc.nhs.uk
For more details on the programme, please contact Innovation Agency Project Manager Michael.Foo@innovationagencynwc.nhs.uk.
System levers to achieve CVD ambitions
Public Health England has identified lipids management as a key area of improvement. Over the next three years, the AHSN programme will focus on:
-
detection of people with FH
-
improvement in the management of people with resistant high cholesterol
Key national support initiatives
CVDPrevent audit
A national audit that will identify key areas of improvement for primary care.
Directed Enhanced Service (DES) scheme
A national programme to support primary care in achieving improvements 2021/2022
Accelerated Access Collaborative
A number of products have been funded through this approach, including PCSK9i
NICE-endorsed pathways for lipids and statins intolerance
Supporting clinical guidance CG181, CG 71, and technology assessments TA385, TA394
Outcomes
Outcomes will be measured in accordance with national metrics:
Improving the numbers of patients with high cholesterol managed in accordance with NICE guidance
Increasing the numbers of patients identified with FH
Improving the number of appropriate referrals to lipid clinics
Improving the number of appropriate referrals to lipid clinics
Current projects
We currently have several improvement projects with primary and secondary care:
- In Liverpool we are working with Cardiac Rehab Nurses to optimise lipids in patients
- Working with Southport and Formby PCN we are optimising lipids in general practice for secondary prevention patients
- We are supporting Winsford PCN with GP-led optimisation of lipids in primary care
- In Blackpool we are working on adopting a proactive approach to identifying patients with FH
- Halton primary care lipids improvement project (Control Cholesterol)
- Knowsley community pharmacy lipids improvement project (Control Cholesterol)
