Posted on January 30, 2025
It is recognised that treating high cholesterol can reduce a patient’s chances of having a cardiac event such as a heart attack or stroke) by around 23%.
Health Innovation West of England worked with One Care, the GP federation for Bristol, North Somerset and South Gloucestershire (BNSSG), and five primary care networks (PCNs) in the wider Bristol area to deliver an innovative project focused on encouraging patients who have had a cardiac event to get their cholesterol reviewed.
Primary care practices were supported to use case finding tools developed by UCL Partners (UCLP) – to identify high risk patients and invite them for a review. Most practices delivered this through their clinical pharmacists, while in one PCN it was delivered by GPs alongside their routine caseload.
Health Innovation West of England provided targeted training to support clinicians to manage patients in line with NICE lipid management pathway national guidance.
Findings show the project has had a positive impact for both patients and clinicians, and has identified useful insights and considerations for similar future projects.
Anil Singh, Senior PCN Pharmacist: “The collaborative lipid project really helped our Pharmacists and Pharmacy Technicians focus their efforts on reducing cardiovascular disease. As a result, not only do we have better patient care and medication compliance but a much greater understanding within our PCN”.
The challenge
Cardiovascular disease (CVD) is a general term for conditions affecting the heart and blood vessels and causes 25% of all deaths in England. CVD is also a health inequalities issue and is the largest contributor to unfair and avoidable differences in health across the population, with people living in the most deprived communities (areas of low income, employment, education etc) having poorer health outcomes than the least deprived communities.
High cholesterol (also known as high lipids) is when you have too much fatty substance called cholesterol in your blood and is recognised as a significant risk factor for developing CVD. It is known that, for every 1mmol/L reduction in low density lipoprotein cholesterol (LDL-C), the risk of patients having a cardiovascular event is reduced by around 23%.
Five PCNs across the wider Bristol area were identified by Health Innovation West of England, One Care and the BNSSG Integrated Care Board (ICB) as requiring targeted support. These were situated within deprived communities known to have poorer health outcomes and in need of improving cholesterol management for their patients.
Our approach
NHS England and Novartis Pharmaceuticals made the Collaborative Lipid Fund available to Health Innovation Networks in early 2023 to deliver projects that improve lipid management.
Health Innovation West of England used this funding to support GP practices within the five identified PCNs to run searches within their patient records to identify patients who had had a cardiac event (heart attack/stroke) and had high cholesterol.
These searches were undertaken using specific case finding tools known as UCLP proactive care frameworks, which also categorised patients into four priority groups:
- 1.Patients not currently taking statins to manage high cholesterol
- 2a. Patients taking a statin, but not the best one for their needs
- 2b. Patients taking a statin, but not on the right dose for full effectiveness
- 3. Patients with a non-high-density lipoprotein (HDL) blood test of higher than 2.5 even whilst on the strongest statin dose they can tolerate.
Groups 1 and 3 were targeted for this project and the overall target population was above 4,600 patients.
In four out of five PCNs, clinical pharmacists led and delivered this project by reviewing and managing patients. In the other PCN this was delivered by GPs alongside their routine caseload.
Health Innovation West of England worked with practices to provide targeted training webinars, supporting clinicians to manage patients in line with NICE lipid management pathway national guidance.
One Care collected data throughout OneCare CIC to assess the project impact.
Clinicians involved in the project received the following positive, patient feedback:
- “Thank you so much for looking after me and making sure I stay healthy.”
- “I didn’t realise how important this [diet & lifestyle] is at my age [40s]. Thank you for all the information and your help.”
- “I had no idea my risks are so high. Thank you for keeping me safe.”
Impacts to date
- Data demonstrated an increase in the number of patients who were reviewed as part of this project.
- Throughout the course of the project over 56,000 contacts were made with these patients, including text messages, telephone calls and face-to-face appointments.
- Key learning has been gained from this project that will help shape future projects in similar areas delivered by Health Innovation West of England.
- Greater PCN understanding of lipid management.
The following longer-term impacts would be expected as a result of improved lipid management:
- Reduced CVD events/complications.
- Reduced hospital admissions.
- Improved health outcome and life expectancy.
- Reduced lipid health inequalities.
This project started in January 2024 and ended on the 31 October 2024. Evaluation started in November 2024 and the final report was submitted to our national colleagues at the end of December 2024, this will be published in due course.
To find out more, contact Amy Bowden, Senior Project Manager on Amy.bowden4@nhs.net or view our Cardiovascular Disease webpage.
