Nurse-led secondary prevention lipid clinic

Background Secondary prevention of cardiovascular disease (CVD) is critical to reducing recurrent major adverse cardiovascular events (MACE) and long-term healthcare burden 1. Effective reductions in elevated LDL-cholesterol (LDL-C) has been consistently shown to improve MACE in patients with established atherosclerotic CVD (ASCVD) 2, 3. The UK National Institute for Clinical Care and Excellence (NICE) recommends secondary prevention LDL-C treatment target of <2.0mmol/L (4) whereas the European Society of Cardiology Guidelines recommend a LDL_C target of <1.4 mmol/L and a ≥50% reduction from baseline 5. Initiatives designed to improve the delivery of secondary prevention of ASCVD can play a fundamental role in improving lipid lowering and patient outcomes 1, 6. Purpose We aimed to assess the efficacy of a novel secondary prevention nurse-led clinic to improve Lipid Lowering therapy regionally Methods This was a prospective examination of the efficacy of our regional nurse-led secondary prevention service. Consecutive patients with a history of established ASCVD and a baseline serum LDL-cholesterol (LDL-C) >1.4 mmol/L at the index admission were included. ASCVD was defined as a history of confirmed acute coronary syndrome (ACS), previous coronary revascularisation for flow-limiting coronary artery disease (CAD), or with a stenosis of >70% in a major epicardial coronary artery. The primary outcome was the change in LDL-C from baseline to six months which was examined using a Repeated Measures Anova with a Tukey post-test. The secondary outcomes were the proportion of patients achieving the NICE LDL-C target of <2.0 mmol/L and the ESC Target of <1.4mmol/L (using Chi-Squared Test). Results We examined 201 consecutive patients. The mean (± standard deviation) age was 66.30±10.71 (range 32.0-90.0) years of which 132 (65.67%) were men. In total 111 (55.22%) patients had suffered an acute coronary syndrome. The mean ± standard deviation LDL-C was 3.16 ±1.91 mmol/l at the index hospital admission, 2.31±0.87 mmol/l at three months (baseline visit) and 1.92±0.73 mmol/l at six months (p<0.001) Figure 1). The mean LDL-C reduction from baseline to six months was 1.24 (95% CI:1.04 -1.44) mmol/L and a 38.61% relative risk reduction. The proportion of patients at six months who achieved an LDL-C target of <2.0mmol/l and <1.4mmol/L was 65.2% and 18.4% respectively (P<0.001). Overall,11/201 (5.5%) were commenced on injectable lipid lowering therapy with PCSK9 inhibitors within six months of their index admission. Conclusions The introduction of a nurse-led secondary prevention service led to a significant reduction in LDL-C and improvements in regional lipid lowering performance. Whilst nearly two thirds of patients achieve the NICE lipid lowering target of <2.0mmol/L at six months post index ASCVD event less than 1 in 5 achieve the ESC target of <1.4mmol/L.