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Working together to prevent cardiovascular disease

Written by: Labeeb Azim - 28th September 2021

To mark World Heart Day, our project manager Labeeb Azim explains the work undertaken with our partners to help tackle cardiovascular disease (CVD).

 

The pandemic has impacted us all in different ways, placing even more importance on looking after our health and mental wellbeing.

Cardiovascular disease (CVD) remains the world’s number one killer. In England CVD is the biggest cause of death and disability with 1 death every 4 minutes, it accounts for the largest gap in health life expectancy. CVD has many causes from smoking, diabetes to high blood pressure, cholesterol and obesity.

One of the projects I am involved in focuses on helping people to improve their ‘heart health’, in particular improving patient care and outcomes by effectively treating patients with high cholesterol. This is part of a wider national programme – Lipid Management and Familial Hypercholesterolaemia – supported by the AHSN Network to help reduce the risk of cardiovascular disease.

Familial hypercholesterolemia is caused by a gene alteration that’s passed down from one or both parents. People who have this condition are born with it. This change prevents the body from ridding itself of the type of cholesterol that can build up in the arteries and cause heart disease.

The NHS Long Term Plan highlights cardiovascular prevention as a key priority for the NHS to improve the nation’s health including early diagnosis of Familial Hypercholesterolaemia (FH).

It also sets out an ambitious ten-year commitment to prevent and manage other high-risk conditions such as atrial fibrillation (AF), high blood pressure and high cholesterol that can lead to heart attacks and strokes. Improving the detection and management of these high-risk conditions is essential to help reduce the chances to develop CVD.

Although treatment of these conditions is highly effective at preventing CVD, under treatment is common and there is substantial geographical variation.

We are working with different stakeholders across the region from primary care networks (PCNs), to Trusts and industry to help improve CVD prevention, including the identification and diagnosis of patients with Familial Hypercholesterolaemia and management of patients with high cholesterol. This is part of a joint programme of work delivered in partnership with the Accelerated Access Collaborative (AAC) Rapid Uptake Product Lipid programme.

We are also working with NHS England and NHS Improvement and Novartis as delivery partners for a novel anti-cholesterol drug, Inclisiran. Inclisiran is the first of a new type of cholesterol-lowering treatment which boosts the liver’s ability to remove harmful cholesterol from the blood.

What are the advantages for our patients?

  • To improve the detection of at-risk patients and optimising lipid management reducing CVD morbidity and mortality
  • Increased identification and treatment of FH patients including adoption of FH testing more widely across primary and secondary care
  • Increased uptake/prescribing of high intensity statins (HIS), ezetimibe and PSCK9 inhibitors, medications that are proven to help lower high cholesterol
  • Increased prescribing of Inclisiran for those eligible

In West Yorkshire, we’re expanding on our work with the West Yorkshire and Harrogate Healthy Hearts project to ensure that lipid management is embedded into the work of PCNs as well as aligning the national and local priorities around blood pressure monitoring.

One of the main challenges we face is medicine adherence. Many people have reservations about the use of statin medication to help lower high cholesterol. We are working to overcome this by developing educational resources both for patients and clinicians as well as working with our primary and secondary care networks.

We’re also working to increase access to genetic testing for Familial Hypercholesterolemia utilising screening of electronic records and piloting a process called Child-Parent Screening which will enable early diagnosis and treatment for those at genetic risk of sudden cardiac death.

Work with our Pathway Transformation Fund (PTF) projects in Sheffield and Hull are also well underway where we supported bids to secure NHS England and NHS Improvement funds to help remove barriers to implementation of the pathway, specifically around referral to secondary care and PCSK9i prescribing.

In our region so far:

  • We have identified 107,000 patients that have benefited from being prescribed Ezetimibe
  • Achieved 99.8% target of HIS prescriptions as a proportion of all statin prescriptions
  • 717 patients currently taking PCSK9i inhibitors

If you would like to be involved in any of our projects, please email me at Labeeb.azim@yhahsn.com.