Since NICE guidance for cardiovascular disease (CG181) was issued in 2014 there has been a steady decline in the use of low intensity statins in favour of those which achieve the desired . Complexities around comorbidities, commonly held misconceptions around statin intolerance and the little understood ‘what next’ when LDL-C targets aren’t achieved have prevented optimal lipid management for many of our patients. The result; avoidable heart attacks and strokes with associated morbidity and mortality, increased pressures on acute services, inappropriate referrals to lipid clinics and extended lipid clinic waiting lists.
Lipids are blood fats, called cholesterol and triglyceride. Patients with high cholesterol are at increased risk of cardiovascular events such as heart attacks, stroke and vascular dementia.
In December NICE launched the long-anticipated updated lipid management pathway. The updated pathway summarises national guidance for lipid management for prevention of cardiovascular disease. It aims to provide clinicians with a clear outline of available treatment options and introduces NICE-approved novel treatments.
If adopted, it offers the opportunity to improve the cardiovascular health of the patients we serve and support the NHS Long Term Plan vision of preventing 150,000 cardiovascular events by 2029. Adoption of the pathway will also enable clinicians to identify suspected familial hypercholesterolaemia and appropriately optimise patients’ lipids within primary care; reducing inappropriate referrals to secondary care and waiting time for those who need specialist intervention.
Population health management is an approach which uses data to identify and prioritise patients who could benefit most from treatment, directly addressing health inequalities. It allows us to understand current health and care needs and predict what local people will need in the future.
Every 1mmol/L reduction in LDL-C achieved through statins reduce risk of major vascular by about one-quarter during each year after the first[1], yet there is inadequate optimisation of lipids in high and very high-risk patients across primary and secondary care[2]. Cardiovascular disease is a population-wide condition directly linked to health inequalities.
Our already hectic primary care teams need support to adopt the updated pathway and new approaches to manage this cohort of patients. A population health management approach enables the identification and management of those patients who have fallen through the gaps, it allows our busy workforce to case find and prioritise care for those most at risk: for example those with chronic kidney disease, QRisk?20% or with Type 1 diabetes. It offers the opportunity to use our workforce differently, using the additional roles reimbursement scheme to trial alternative delivery models, perhaps engaging care coordinators and pharmacists at PCN-level to lead local lipid clinics to identify and support the management of these patients.
I am pleased to be working as a clinical advisor with Health Innovation East to support our region in demystifying the new lipid management pathway. Over the coming months we will be delivering CCG-wide training sessions to support our primary care colleagues in understanding the pathway, empowering clinicians in their shared decision making and supporting the implementation of these novel therapies and their appropriate use.
To support a comprehensive population management approach, Health Innovation East is also investigating and piloting risk stratification tools which identify patients who may require lipid optimisation. They are supporting the set-up and evaluation of a pharmacist-led lipid clinic at practice level to distribute work throughout our primary care workforce. We hope to take the learning from this and adopt a similar approach throughout the region.
I am excited to be working with Health Innovation East at a time when novel approaches to managing cardiovascular disease could significantly improve the health of our patients.
If you would like to learn more about our work on lipid management and available resources visit our CVD page or contact Amy Miller, Senior Advisor, Amy.Miller@healthinnovationeast.co.uk.
I have been a GP in North East Essex for 28 years and had various leadership roles in health service commissioning and developing cardiac care in Essex. I also developed and ran innovative new services such as community Holter monitoring and in 2012 and achieved a Diploma in Cardiology at Bradford university. I now work as a sessional GP and a GP with special interest in Cardiology. In addition to being a Board member of North East Essex CCG I am also joint Clinical Director for community services in North East Essex.