From 2021 the 15 HIN's have focused on enabling the NHS to optimise lipid management in people at increased cardiovascular risk. To support these long term ambitions through a CVD Programme (led by the team at North East and North Cumbria HIN), the objectives are;
Across Wessex, delivery of the programme incorporates AF activity already established and brings together work to support the NHS Accelerated Access Review Rapid Uptake Product (AAC RUP). The Rapid Uptake Product element of the programme is a novel, NICE-approved clinical pathway, focusing on secondary prevention.
HIW's lipid management effort is focused on pathway improvement for hyperlipidaemia management.
Why are we doing it?
Cardiovascular disease (CVD) is a leading cause of death in the UK1. 85% of all CVD deaths are due to myocardial infarctions (heart attack) or strokes2
As many as 28% of cardiovascular related deaths are attributed to elevated cholesterol. Despite evidence that interventions that lower LDL-C will significantly reduce the incidence of coronary heart disease and other major vascular events, identification, diagnosis, referral and appropriate management with at risk patients remains varied across England.
What’s happening in Wessex?
The team at Wessex have been engaging with local stakeholders to understand current practice and local challenges better.
The project will support the local efforts to optimise the detection and management of at-risk patients and support the use of lipid lowering medicines across Wessex through large scale education events and smaller, more targeted clinics.
We will also be conducting lipid pathway mapping exercises across Wessex services, both in primary and secondary care, to understand if/where there are gaps in services with the longer term aim of ensuring equity of access.
The work will be supported by local and national data, appropriate tools to identify patients, and ensure risk stratification includes added risk to ethnic minority populations and a proactive approach to support this cohort.
References
National Guidance, Supporting Policies and Contractual Frameworks
The NICE guideline CG181 includes recommendations on risk assessment for CVD and on the use of lipid-lowering drugs. The original guideline is updated in part to allow consideration of new evidence on risk assessment tools and to reflect changes in price and availability of generic statins. NICE has produced guidance on other modifiable risk factors for CVD and this guideline should be used in conjunction with it. You can review guidance on other risk factors here and here.
“We’ve come a long way, but cardiovascular disease (CVD) still causes a quarter of all deaths in the UK, and it remains a major driver of health inequalities. But it doesn’t have to be this way. Cardiovascular health is determined in part by a range of modifiable factors. So, by focusing on CVD prevention, we have a tangible opportunity to close the health gap. We can do this in 2 ways. First by reducing the risk of developing CVD for millions more people with population-level interventions to create a healthy environment. And second, by detecting, diagnosing, and effectively managing high-risk conditions as early as possible to help prevent acute cardiovascular events and associated long-term conditions.”
John Maingay - Director of Policy and Influencing at the British Heart Foundation
You can read more from the NICE Impact Report on CVD Prevention here.
Clinical Pathways
To support delivery of this part of the NHS Long-Term Plan, the Accelerated Access Collaborative (AAC) Lipid Management Rapid Uptake Product (RUP) Working Group have developed a NICE-endorsed clinical pathway along with a companion document for statin intolerance:
The aim of these pathways is to simplify and encourage adherence to national guidance for optimal management of patients at high risk of CVD and reducing the incidence of heart attacks or strokes.
Handbook for setting up Lipid Management in primary care