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Implementing an Innovative Lipid Management Technique Using siRNA LDL-C Lowering Therapy: Lessons Learned in an NHS
Carl Deaney1, Meredith Donaldson1, Agne Meskauskiene1
1Marsh Medical Practice, Louth, Lincolnshire, UK.
Insights
This UK general practice implemented a new siRNA therapy for lipid management to prevent cardiovascular events. The approach successfully identified at-risk patients and integrated the treatment into primary care, demonstrating achievable enhanced lipid management.
Area of Science:
- Cardiovascular Disease Research
- Pharmacology
- Public Health Initiatives
Background:
- The UK Government launched a population health agreement to combat cardiovascular disease (CVD).
- The initiative aims to prevent 150,000 strokes, heart attacks, and dementia cases over 10 years.
- Inclisiran, a novel siRNA therapy for lowering LDL cholesterol, is central to this strategy.
Purpose of the Study:
- To share real-world observations of Inclisiran implementation in UK primary care.
- To assess the potential service benefits of this innovative lipid-lowering therapy.
- To address patient identification strategies for atherosclerotic cardiovascular disease (ASCVD) risk.
Main Methods:
- A multi-disciplinary team (MDT) education program utilized existing resources from AHSN and NICE.
- Automated software searches and manual case-finding identified at-risk patients.
- Multi-channel patient invitations, informed consent, and automated recall systems were employed for treatment and follow-up.
Main Results:
- Enhanced lipid management is achievable within primary care, aligning with national guidelines.
- The implemented methodology and training facilitated rapid identification of eligible patients.
- A holistic, multi-disciplinary approach minimized service burden on general practitioners (GPs).
Conclusions:
- Integrated care services can effectively deliver advanced lipid management programs.
- Leveraging external educational resources supports primary care MDT upskilling and reduces training burdens.
- The initiative demonstrates a successful model for proactive CVD prevention through enhanced lipid management.
Introduction:
The UK Government partnered with industry to tackle cardiovascular disease (CVD) in the first NHS population health agreement. The ambition was to prevent 150 000 strokes, heart attacks and dementia cases over the next 10 years with a new siRNA LDL-C lowering therapy (Inclisiran) delivered within Integrated Care Services by primary care to support a comprehensive approach to lipid management. Following the approval of inclisiran, and guidance published by the National Institute for Health & Care Excellence (NICE) on its use, this paper has been created by a UK general practice to share real-world observations of cases and the potential service benefits of rolling out this innovative drug treatment. The process of identifying patients at risk of atherosclerotic cardiovascular disease (ASCVD) and lessons learned from implementing in practice is also addressed. Workstreams were developed to rapidly roll out a low clinical burden enhanced lipid management program incorporating siRNA LDL-C lowering therapy into primary care practice.
Approach/Method:
(1) Multi-disciplinary team (MDT) education program based on freely available Academic Health Science Network (AHSN), National Institute for Health & Care Excellence (NICE), and commercial materials. (2) Automated searches using a software program were run to identify "at-risk" patients alongside manual case-finding in everyday clinics. (3) Patients were invited for review using multi-channel modalities. (4) Where appropriate, treatment was commenced after consent was obtained. (5) Automated recall systems are used to ensure follow-up; initially at 3 months, then every 6 months.
Discussion And Conclusions:
Enhanced lipid management as a secondary prevention measure is achievable in line with national guidance and objectives. The methodology and education/training processes used in combination with reconstructing the management process can help practice staff realize the program benefits, which in turn can lead to a shift in behavior where all staff embed manual case-finding of high-risk patients into everyday consultations and reviews; enabling rapid identification of eligible patients. Taking a multi-disciplinary, holistic approach to new initiatives reduces service burden, particularly for GPs. Leveraging resources from the AHSN and others removes additional training pressures often associated with new initiatives and provides a wealth of educational material to support primary care MDT upskilling.
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