A medication optimisation pilot service for patients with cardiovascular disease

Summary

This pilot service focused on patients who had had a cardiovascular disease (CVD) event (for example, a heart attack). The aim was to optimise their medication utilising the skills of specialist cardiology pharmacists either through new clinics or increasing support to existing cardiac rehabilitation teams. There was a particular focus on understanding the patient’s individual situation and overcoming barriers to effective optimisation, such as a lack of understanding or side-effects. Furthermore, activities also covered community engagement in raising awareness of CVD and a healthy lifestyle.

The challenge

Across Cheshire and Merseyside, there is unwarranted variation by practice of patients not being managed to optimal lipid levels. Data from CVDPREVENT national primary care audit shows that this is also true for patients who have had a cardiac event. Optimisation of secondary prevention medicines is frequently not possible during the original hospital stay and later optimisation in primary care is suboptimal. Cardiac rehabilitation teams are currently not resourced to provide the comprehensive medication reviews required. The aim of this work was therefore to establish a proof-of-concept for pharmacist-led medicines optimisation clinics for patients after a CVD event. The focus was to ensure these are optimised early after an event to minimise risk of further CVD events.

Actions

The project focused on providing a holistic review of all secondary prevention medicines including lipid optimisation. The focus was on those who had had a recent CVD event when motivation is still high, but those who had an event in the preceding 6-9 months and met eligibility criteria also attended these clinics. Uptake of newer lipid therapies for patients who are intolerant or inadequately treated with high-intensity statins and not achieving target is limited across the region. Providing a clear management plan via this pilot service provides education to primary care clinicians around the use of novel therapies and will help to embed Accelerated Access Collaborative (AAC) guidelines, ultimately benefiting patient treatment. Clinics were staffed by existing specialist cardiology pharmacists involving four clinics across five hospital trusts in Cheshire and Merseyside.

Role of Health Innovation North West Coast

Health Innovation North West Coast project-managed this proof-of-concept pharmacist-led comprehensive medicines optimisation service by taking a central role and liaising with relevant departments at each trust, as well as overseeing data collection and analysis.

Health Innovation North West Coast worked with regional lipid experts to deliver a webinar series to the region, Mastering Cholesterol – CVD Prevention. The series covered various topics including Targeting lipids: a primary and secondary care perspective, and Driving LDL-C to target: novel lipid therapies. Over 500 participants registered for this webinar series, which can be viewed via this link.

Results and outcomes

The patient consultations took place between August 2023 and June 2024 and included first appointment and follow-up consultations if required. A summary of the results:

• All 384 patients seen across the four clinics received a medicines optimisation review and those discharged from the service received a comprehensive management plan
• By the end of the pilot service, 73 per cent of the patients seen were meeting national targets for low-density lipoprotein (LDL) cholesterol levels (2.0 mmol per litre or less, as per NICE guidance for secondary prevention of CVD).
• 192 patients were referred by cardiac rehabilitation teams
• 59 patients were prescribed non-statin-based lipid therapies
• 260 patients were screened for atrial fibrillation either by routine ECG assessment or manual pulse palpation
• 691 non-pharmacological interventions were made, including signposting for smoking cessation, referral into local lipid clinic, referral for familial hypercholesterolaemia screening and dietary/lifestyle advice.

The patient satisfaction survey (which had a 71 per cent completion rate) showed highly positive feedback with 96-98 per cent strongly agreeing that the appointments helped them understand more about heart medicines, felt involved in decisions about their medications, and felt more confident in managing their medications with a clear plan provided by the pharmacist.

The Health Innovation North West Coast Heart Heroes were an integral part of the community engagement aspect of the project, reaching out to the public and raising awareness of CVD and a healthy lifestyle. The Heart Heroes attended five community events across Cheshire and Merseyside and performed 204 health checks. This project has also supported a series of community events in Cheshire West aimed at cardiovascular health promotion, in particular by providing advice and by supporting a nutritionist to engage with members of the public to explain cholesterol and blood pressure and what target levels should be, and how to help manage them with diet and exercise. During these community pop-up events they engaged with 132 members of the public.

Next steps

The pilot service was well received by both clinic staff and patients. Health Innovation North West Coast and project partners now aim to disseminate the findings and share the learning with stakeholders across the region.

Testimonial

Marc Vincent, Deputy Chief Pharmacist at Liverpool Heart and Chest Hospital NHS Foundation Trust, who led the project, said:

‘Health Innovation North West Coast were brilliant in project-managing this piece of work which tackles on of our region’s toughest challenges. The team were excellent in the way they convened all the people we needed to make it work, and I was impressed by their energy and determination to carry it through. They were always available to take questions and really drive the project forward.’