Imperial College Healthcare NHS Trust (Hammersmith Hospital Lipids Department)

Project Name: Imperial tertiary lipid service development

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 for the enhancement of the tertiary lipid service.

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) in response to the needs of the CW Partner.

The CWP will be led by the CW Partner’s Lead Nurse, alongside a multi-disciplinary team; including Lipidologist, Cardiologists, and a Clinical Pharmacist, aiming to achieve:

• Identification of patients with ASCVD and those who are at high risk of, and commence their lipid treatment pathway according to NICE and local guidelines
• Identification of sub-optimally treated ASCVD patients and those at high risk of, who are not achieving lipid levels as specified in local guidelines
• Identification ASCVD patients and those at high risk of, who have previously not tolerated or refused alternative lipid modification therapies
• Review of treatment options and decide the next best course of action in collaboration with ASCVD patients or patients at high risk of ASCVD.
• Counsel ASCVD patients or patients at high risk of ASCVD where appropriate.

This CWP has been amended, to include additional funding for one 1.0 full time equivalent (FTE) band 6 clinical nurse specialist (CNS), and one 0.1 FTE CNS to offer subsequent supervisory support to undertake lipid clinic activities in the CW Partner’s hyper-acute stroke unit (HASU). The CW Partner feels the addition to the HASU team will demonstrate a closer working model to that described in the AHSN Pathway

Planned Milestones:

Expected Benefits:

Patient benefits

• 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 lipid therapies for suitable patients to preserve health and prevent long-term events 

Organisation Benefits

• Increased proportion of patients who have ASCVD or at high risk of, reviewed by the lipid service
• Increased proportion of patients who have ASCVD or at high risk of, receiving expert and timely reviews
• Increased proportion of patients receiving guideline-directed pharmacotherapy  

Novartis benefits 

• Insight on the use of ASCVD licensed medicines in line with NICE guidelines, including Novartis’s medicines, where appropriate.
• 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: December 2022 for 26 months

Ammendment Feb 2024 – to the end of the project

FA-11449892 | June 2025

Project Name: Imperial tertiary lipid service development. 

Organisation(s): Imperial College Healthcare NHS Trust (Hammersmith Hospital Lipids Department) (the “CW Partner”) .

Completion Date: 22 July 2025

Outcome Summary: 

This CWP has improved lipid optimisation for acute ischemic stroke patients admitted to the Hyper Acute Stroke Unit:98.61% patients received lipid lowering treatment in line with Health Innovation Network (HIN) pathway. Additionally, a stroke lipid clinical nurse specialist (CNS) clinic and post-stroke lipid clinic have been newly established at Charing Cross Hospital, offering same day lipid profile analysis and treatment to eligible stroke and transient ischemic attack (TIA) patients, respectively.

Key Project Outcomes Data: 

Key Outcome Data:

Proportion of acute stroke and TIA patients who are managed according to HIN pathway:

• 98.61% (500/507 patients)

Lipid lowering among acute stroke and TIA patients:

• 98.02% were discharged with high intensity statin.
• 1.18% with Medium intensity statin.
• 0.60% on cholesterol absorption inhibitor and 0.19% on adenosine triphosphate-citrate lyase (ACL) inhibitors.

Proportion of acute stroke and TIA patients who reached Low-Density Lipoprotein Cholesterol (LDL-C) target at follow up:

• 71.18% (84/118 patients).
• Out of the 84 patients who reached target LDL-C at follow-up, 13 are TIA patients.

Proportion of acute stroke and TIA patients who did not reach LDL-C target at follow up:

• 28.81% (34/118 patients).
• 44.11% (15/34 patients) with LDL-C ≥2.6 = 46.66% (7/15 patients) were given RNA interference (RNAi) therapeutics in post-stroke lipid clinic, remaining 53.33% (8/15 patients) refused injectable therapeutics after discussion.
• 55.88% (19/34 patients) with LDL-C 1.8-2.6 = medications up titrated / compliance checked / other medications advised after discussion.

Outcomes: 

This CWP has led to the following improvements in several key areas, benefiting the Imperial stroke lipids service, the NHS, the stroke patients, and Novartis. Primary outcomes included improved lipid optimisation for acute ischaemic stroke and TIA patients.

For Imperial stroke lipids service:

• Improvement in lipids blood test: 100% patients had their lipids tested at admission (previously 85%) and at follow up in 6-8 weeks (previously 21%) post discharge. This significant improvement has helped in initiating lipid lowering therapies accordingly with Health Innovation Network (HIN) pathway, i.e., 98.61% patients.
• Expansion of service: 1) A stroke lipid CNS clinic has been set up to review patients at their stroke medical follow up appointment at 6-8 weeks post discharge. Patients are reviewed and their lipid profile blood test is tested using a point-of-care (POC) machine (or lab bloods in some cases) to determine the LDL-C levels. A total of 118 patients were reviewed in the clinic and were advised accordingly regarding lipids optimisation. 2) A post-stroke lipid clinic has also been established by Dr Joseph Kwan to provide further consultant-led discussions and treatment therapy for eligible stroke / TIA patients.
• Improved waiting time for blood test and streamlining decision making: Patients are actively involved right from their admission to Hyper Acute Stroke Unit (HASU) in management of lipids. Patients do not need additional blood test appointment at their follow up and lipid management decision are made on the same day after discussion with patient and liaising with stroke consultants.
• Faster referral to treatment: Significant improvement in patient referrals to appropriate services. Patients who will benefit from being reviewed by a lipidology consultant (e.g., with familial hypercholesterolaemia) are referred to the Lipid Clinic at Hammersmith Hospital, and patients who will benefit from treatment are reviewed in the new twice-monthly post-stroke lipid clinic. Additionally, other stroke consultants can now refer patients to the post-stroke lipid clinic.
• Improved service efficiency: Targeted secondary prevention education and lipid management in the HASU have resulted in more streamlined management and improved clinical outcome in acute ischaemic stroke/TIA patients.
• The project has improved lipid optimisation for patients with an acute ischaemic stroke/TIA by educating patients on the importance of lipid management in reducing the overall risk of a stroke, TIA and other cardiovascular events thus improving NHS service.

Conclusion: 

This collaborative working project has improved lipids optimisation in acute ischaemic stroke and TIA patients according to national guidelines, resulting in a more efficient stroke lipid service, significantly improved patient care, and potentially better outcomes.

References:

• Singh P, Perry C, Cann A, Banerjee S, Cegla J, Kwan J. Lipid optimisation for patients with transient ischemic attack: benchmarking against UK national guideline (Abstract 2025). 16th World Stroke Congress Abstract, 23-26th October 2024, Abu Dhabi, UAE. World Stroke Journal 2024;19 (Issue 2 suppl):397
• Perry C, Cann A, Singh P, Banerjee S, Cegla J, Kwan J. Lipid optimisation for acute stroke patients: benchmarking against UK national guideline (Abstract 2979). 10th European Stroke Organisation Conference Abstracts, 15-17 May 2024, Basel, Switzerland. European Stroke Journal 2024;9 (Issue 1 suppl):513-514.
• Udayan A, Barton L, Banerjee S, Kwan J, Cegla J. Introduction of a new Stroke lipid specialist nurse to improve lipid optimisation for acute ischaemic stroke patients. 37th Heart UK Annual medical and scientific conference, 10-12 July 2024, Coventry, United Kingdom.
• Udayan A, Barton L, Kwan J, Choudhury S, Cegla J. POC lipid profile measurement as an alternative to lab profile in patients with acute ischaemic patients . 37th Heart UK Annual medical and scientific conference, 10-12 July 2024, Coventry, United Kingdom.

FA-11523655 | November 2025