Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London. SW9 9NH

Project Name: Pharmacist Led Lipid Service at West Middlesex University Hospital

Project Summary:

The CWP is structured such that a multi-disciplinary health professional team will provide tailored care for patients, aligned with the Primary Care Network (PCN) Contract Direct Enhanced Service (DES) and the locally defined cardiovascular plans.

The main objective of the CWP is to improve the quality of care for patients and support the early identification, review, and medical optimization of patients with atherosclerotic cardiovascular disease (ASCVD) who are at high risk of cardiovascular events and who are not achieving lipid levels as specified in national and/or local guidance, in response to the needs of the CW Partner. Novartis will contract with Chelsea and Westminster Hospital NHS Foundation Trust as they are the legal entity acting on behalf of the following locations.

• Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH
• West Middlesex University Hospital, Twickenham Road, Isleworth, TW7 6AF

This CWP aims to support the cardiology department at West Middlesex University Hospital with a 0.3 FTE Band 8b Specialist Pharmacist and 0.1 FTE Consultant Clinical Pharmacologist / Acute Physician.  The aim will be to optimise lipid therapy for people with ASCVD in West Middlesex University Hospital and from referrals received from PCNs in the Hounslow area.

The CWP will be led by a Specialist Pharmacist and Consultant Clinical Pharmacologist / Acute Physician alongside a multi-disciplinary team; including the borough CVD champion, Specialist Nurses, Trust HR Associate, Administrator, General Practitioners, and PCN Pharmacists aiming to achieve:   

1. Identification of sub-optimally treated ASCVD patients who are at high risk of cardiovascular events and who are not achieving lipid levels as specified in national and/or local guidelines.
2. Identification of ASCVD patients who are at higher risk of cardiovascular events and who have previously not tolerated or refused alternative lipid modification therapies.  
3. Review of treatment options and decision on next steps in collaboration with ASCVD patients
4. Counsel and optimize ASCVD patients where appropriate.  
5. Early identification of at-risk patients who have not had intervention in their health and wellbeing. 
6. Identification of ASCVD patients, following risk assessment review, of ASCVD patients who are sub-optimally treated.  
7. On-going ASCVD patients support and annual review to ensure CVD outcomes improve equitably. 
8. Education of clinical team in primary care on managing lipids including newer therapies to improve appropriate referral and shared care management.

Planned Milestones:

Expected Benefits:

For the Patient:

• Improved access to lipid management care leading to optimal diagnosis and management of ASCVD treatments.   
• Enhanced experience around ASCVD with ongoing management of the condition.   
• Improved access to appropriate medication for suitable patients to preserve health and prevent long-term events.  
• Easier access to lipid management care closer to home in the Primary Care setting
• The additional capacity will provide additional time and support from PCN HCP with their lipid management, focusing on patients who may have previously not attended GP appointment or been lost to follow-up. Thus, leveling health inequalities within the PCN.

For the CW Partner:

• Increased proportion of ASCVD patients reviewed by primary care.   
• Increased proportion of ASCVD patients receiving expert and timely review closer to home  
• Reduction in ASCVD referral rates to secondary care  
• Increased proportion of patients receiving guideline-directed pharmacotherapy  
• Insight into benefits of primary care pharmacist led lipid management clinics in primary care.   
• Support aligned to NHS Long Term Plan, CVDPREVENT, and Network Contract DES 

For Novartis: 

• Insight on the appropriate use of ASCVD licensed medicines in line with NICE guidelines, including Novartis’s medicine.  
• Enhanced reputation and supporting Novartis’ vision that no patient should have to wait for an extraordinary life, by supporting high quality Collaborative Working with healthcare organisations which addresses the problem of health inequalities.    
• Ethical, professional, and transparent relationship between Novartis and the Healthcare Organisation  

Start Date & Duration: November 2023 for 18 months

GB2311201284

Project Name: Pharmacist Led Lipid Service at West Middlesex University Hospital

Partner Organisation(s): Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London. SW9 9NH

Completion Date: 31^st January 2025

Outcome Summary:

While fewer patients were managed in the primary prevention category than planned, over half of the secondary prevention patients achieved LDL-C <1.8 mmol/L. The total number of patients reviewed as part of this project was 215 over 351 clinic appointments and targeted interventions such as initiating high-intensity statins were successfully implemented. This initiative demonstrated enhanced lipid management and improved cardiovascular outcomes.

Key Project Outcomes Data:

• Among 195 secondary prevention patients (mean age: 63 years, 72% male), the mean LDL level decreased from 3.38 mmol/L to 2.04 mmol/L post-optimisation. 
• The highest incidence of pre-existing comorbidities included hyperlipidaemia (50%), coronary artery disease (42%), hypertension (41%), diabetes (40%), cerebrovascular accident (CVA) (11%), and peripheral vascular disease (PVD) (6%). A smaller proportion of patients (5.1%) had no past medical history. LDL-C targets achieved were: <1.4 mmol/L (19.5%), <1.6 mmol/L (36.4%), <1.8 mmol/L (54.9%), and <2.0 mmol/L (66.2%). 
• Interventions included high-intensity statins (15.79%), ezetimibe (33.01%), bempedoic acid (5.74%), injectable lipid lowering therapy (5.74%), and non-pharmacological approaches (21.53%). Notably, 38 patients refused intervention, and 3 were diagnosed with familial hypercholesterolemia (FH). In the primary prevention category, 20 patients were reviewed, with 11 initiated on high-intensity statin therapy. 

Outcomes:

Overall, these results indicate effective identification and management of high-risk patients, with over half of the secondary prevention patients achieving LDL-C <1.8 mmol/L. While fewer patients were managed in the primary prevention category, targeted interventions such as initiating high-intensity statins were successfully implemented, highlighting the potential for expanding primary prevention efforts in future iterations.

Due to increasing financial constraints at the Trust, all business cases have been put on hold, including the business case generated by this project.

Conclusion: 

The primary objective of this project was to improve the quality of care for high-risk ASCVD patient through early identification, review, and medical optimisation, to achieve lipid targets as per national and local guidelines, in a locality which had poor access to specialist support but a high cardiovascular mortality. By integrating data-driven patient identification, multidisciplinary collaboration, and patient-centered care, this initiative demonstrated enhanced lipid management and improved cardiovascular outcomes. The findings provided valuable insights into lipid optimisation strategies, with potential for broader implementation across healthcare settings.

Additional Content: 

A patient video has been developed to address challenges around patient reticence to some therapies. The introduction of the patient support video is expected to further improve outcomes by enhancing patient understanding and adherence to prescribed therapies. Providing patients with access to the video at home, using a unique QR code, reinforces key messages and promotes long-term engagement with lipid management.

References:

• 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Mach F, et al. Eur Heart J 2020;41:111–188
• Ray KK, et al. Lancet Reg. Health Eur. 2023;29:100624

FA-11445914 | June 2025