LIPID MANAGEMENT & FH

Supporting primary care in the prevention and management of cardiovascular disease

PURPOSE

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.

AIM AND OBJECTIVES

The aim of this innovation will be to improve patient care and outcomes by effectively treating patients with hypercholesterolaemia. The objectives are:

  • To increase the numbers of those who have their cholesterol measured and to identify those with conditions that increase familial risk of hypercholesterolaemia
  • 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 more treatment options to high-risk patients who remain at risk despite maximum tolerated statin therapy.

OUR APPROACH

This programme focuses on Familial Hypercholesterolaemia (FH) detection and lipid management optimisation to reduce death and disability due to premature cardiovascular disease. This is part of a joint AHSN-AAC programme of work delivered in partnership with the AAC RUP Lipid programme.

Expanding access to genetic testing for FH via screening of electronic records and piloting a process of child-parent screening will enable early diagnosis and treatment for those at genetic risk of sudden cardiac death. This is imperative as substantial improvements in FH diagnosis have not been made despite publication of  NICE clinical guidelines (CG71) and Quality Standards (QS41).

The Rapid Uptake Product for lipid management element of the programme is a novel, NICE-approved clinical pathway, focusing on secondary prevention.

WHAT IS INCLUDED

The pathway includes the following medicines:

  • High intensity statins:
    • Atorvastatin (20mg to 80mg)
    • Rosuvastatin (10mg to 40mg)
  • Ezetimibe
  • PCSK9 inhibitors (PCSK9i):
    • Alirocumab
    • Evolocumab.

ACCESS

This programme will work with NHS Trusts and Primary Care Services across England to improve the offer to people with known or previously unknown high risk of cardiovascular disease. Specifically, it will accelerate the identification of those with FH and facilitate optimised management of individuals with high lipid levels. This includes using innovative approaches to supplement current clinical assessment processes, underpinned by changes in pathways, workforce and data collection.

High intensity statins and ezetimibe are available as generic medicines and are prescribed in primary and secondary care. PCSK9i are prescribed in secondary care.