The programme is evidence informed and embedded within the NICE endorsed national guidance for lipid management for primary and secondary prevention of CVD. Professor Julia Newton, our Medical Director leads the national programme team which consists of national programme and project managers as well as a PPIE and Education Lead.
The aim of this innovative programme is to achieve the NHS LTP CVD ambitions to improve patient care and outcomes by effectively identifying and treating patients with hypercholesterolaemia including those with the genetic condition familial hypercholesterolaemia (FH).
The objectives are:
- To reduce the risk for heart attacks and strokes occurring
- To reduce the risk of admissions and re-admissions associated with cardiovascular disease
- To reduce health inequalities by ensuring a consistent, national approach to lipid management, using a NICE approved clinical pathway
- To provide a pathway to optimise the identification of those with the genetic condition familial hypercholesterolaemia (FH)
- To provide more treatment options to high-risk patients who remain at risk despite maximum tolerated statin therapy.
Since the launch of the programme in October 2020, stakeholders have collaborated and agreed on a set of programme wide metrics and trajectories to be delivered against annually.
An education programme has been established to support workforce capacity and capability – a key identified programme barrier.
An Equality and Health Inequalities Impact Assessment has also been carried out closely collaborating with the AHSN PPIE workstream, to ensure patients are at the heart of the programme.
All 15 AHSNs have developed their regional Delivery Frameworks supported by the national team to enhance their adoption and spread plans and ensure that they are evidence based and realistic.
A key component of the programme is the refresh, endorsement and sharing of the NICE lipids and statin intolerance pathway through the Clinical Advisory Group, with all key stakeholders to reduce variation in practice.
Other key outputs since the launch of the programme include delivery and programme management of PTF funded Rapid Uptake Products (RUP) projects (first and second wave now complete and third wave which started in April 2022 is currently ongoing), and the commencement of the Child Parent Screening NHSE funded 7 pilot sites.
For PCSK9i, the programme is at 99% of year-to-date trajectory with almost 7800 patients nationally now accessing this treatment.
Following publication of NICE TA 694, “Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia”, the AAC/AHSN teams have successfully worked with a Clinical Leadership group and placed this into the existing NICE endorsed pathway.
September 2021 saw the approval of Inclisiran for secondary prevention.
This novel therapy provides clinicians with an additional option to optimise lipids which has also now also been integrated into the NICE endorsed pathway. https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2020/04/National-Guidance-for-Lipid-Management-Prevention-Dec-2022.pdf
There has been the publication of Talking Head videos which outline the work of the Lipid RUP, the role of the AHSN Network in this, and the importance of Pathway Transformation Funding for supporting implementation. The blog and videos can be accessed. https://www.ahsnnetwork.com/programmes/cardiovascular-disease/lipid-management-and-familial-hypercholesterolemia/
The first child was screened in the Child Parent Screening Service in October 2021 and there are now 31 participating practices with 130 children screened and recruitment still active.
The Network Contract Direct Enhanced Services includes an indicator for the “Percentage of patients aged 29 and under with a total cholesterol greater than 7.5 OR aged 30 and over with a total cholesterol greater than 9.0 who have been referred for assessment for familial hypercholesterolaemia” to incentivise detection and support our programme
Over 2076 patient entries into the national REDCap PCSK9i Audit tool for lipid optimisation using novel therapies.
Development and use of validated primary and secondary care patient search tools.
There has been a 28% increase in the number of Trusts reporting a functioning lipid management pathway between primary and secondary care.
There has been a 38% increase in FH services and 34% for lipid services within Trusts.
177 560 people now take statins and 116 079 of those are high intensity – an increase of 3%.
Those additional 116 079 now taking high intensity statins have reduced their risk of CVD by at least 14%.
9284 more people have benefitted from Ezetimibe.