Project Name: Lipid Optimisation Pathway for Hyper Acute Stroke & Transient Ischaemic Attack (LOPHAT) – ASCVD Risk Factor Management

Project Summary: 

This CWP aims to improve outcomes of patients admitted to the CW Partners Hyper Acute Stroke Unit (“HASU”) by implementing a holistic approach to Atherosclerotic Cardiovascular Disease (“ASCVD”) risk factor management as part of the lipid optimisation pathway for hyperacute stroke and TIA.  This will be achieved by the recruitment of 1.0 full time equivalent (“FTE”) Band 7 Stroke Lipid Specialist Nurse who will work with a multi-disciplinary team to modify the existing pathway by including identification and management of additional modifiable ASCVD risk factors.

The CWP will be led by the CW Partner’s Lead Nurse alongside a multi-disciplinary team including Lipidologists, Cardiologists, Consultants and Clinical Pharmacists aiming to enhance the optimal management of ASCVD risk factors by implementing the following:

  • Protocol development
    • The testing / screening of modifiable ASCVD risk factors, namely:
    • Blood pressure
    • Glucose (HbA1c)
    • Atrial fibrillation
    • Smoking and alcohol
    • Weight
    • Lipid profile
    • Screening for Familial Hypercholesterolemia (“FH”) and measuring Lipoprotein(a) (“Lp(a)”) (measuring Lp(a) in all patients admitted to the Hyper Acute Stroke Unit (“HASU”), according to the EAS Guideline 2022) and referral to specialist lipid service according to the National Clinical Guideline for Stroke2)
    • Follow up stroke patients and measure their lipid profile (TC/HDL-C/LDL-C/Triglycerides) using a point of care (“POC”) device for immediate feedback and discussion of different treatment options for optimal LDL-C control.
  • Patient education and counselling with patient leaflets, focusing on:
    • Nutrition
    • Weight management
    • Physical Activity
    • Sleep quality
    • Diabetic control
    • Treatment / Medicine Optimisation / Risk Stratification
    • Review of treatment options with the patient in HASU and decide on the next best course of action in collaboration with ASCVD patients or patients at high risk of ASCVD
    • Medication optimisation
    • Review of patients at the stroke lipid Clinical Nurse Specialist (“CNS”) clinic at 6-8 week follow-up
    • Referral to specialist lipid clinic or post-stroke lipid clinic

At the CW Partners HASU a Band 6 Stroke Lipid Specialist Nurse was recruited as part of a previous CWP with Novartis. This initiative was within the lipid optimisation pathway for hyperacute stroke and TIA (“Transient Ischaemic Attack”). As a result, 98% of ischaemic stroke patients are discharged according to national clinical guidelines, and 70% of patients achieve the target LDL-C level of <1.8 mmol/L within the first 6-8 weeks (vs 47% baseline). During this project, it was identified that further improvements to the stroke lipid pathway could be made for the benefit of patients. The HASU currently manages around 1,800 stroke referrals annually. Of these, approximately 1,000 patients are not optimally managed for ASCVD risk and could benefit from enhanced and holistic ASCVD risk factor management to improve outcomes and prevent stroke recurrence. This equates to 2,000 patients over the 24-month duration of this project.

All clinical treatment decisions made within the scope of this CWP will be made by the CW Partner. Successful performance against the agreed outcome measures will model an innovative stroke pathway proof of concept that can be replicated across healthcare systems.

Expected Benefits: 

Anticipated Benefits for Patients

  • Improved access to care leading to optimal management of ASCVD risk factors and treatment pathway 
  • Enhanced experience around Cardiovascular risk with ongoing management of the condition.
  • Reduced waiting time of initial assessment, reviews, commencing class program or home based program. Improved access to appropriate medication for suitable patients to preserve health and prevent long-term events 
  • Reduction in health care inequalities
  • Inform cascade screening of family and close relatives to understand ASCVD risk profile for lipid disorders

Anticipated Benefits for CW Partner

  • Increased proportion of secondary care CV patients undergoing optimisation
  • Increased proportion of CV patients receiving expert and timely review
  • Reduction in CV events in patients who have received a review and medicines optimisation and leading to fewer re-admissions.
  • Increased proportion of patients receiving guideline-directed pharmacotherapy 
  • Reduce healthcare inequalities. alleviate current in-service post code lottery of care provided.
  • Support healthcare planning and decision-making through the wider collection of real-world evidence on the burden of Lp(a)

Anticipated Benefits for Novartis

  • Insights into risk factor screening and subsequent management of high-risk patients (including LDL and Lp(a)).
  • 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   
  • Novartis is likely to see positive outcomes as a result of the CWP.  As more patients are reviewed there is a potential for greater utilisation on licenced Novartis’s medicines, in line with national and local guidelines, where appropriate, leading to improved patient care.
  • Ethical, professional, and transparent relationship between Novartis and the Healthcare Organisation 

Start Date & Expected Duration: October 2025 for 27 months

FA-11572145 | December 2025