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Innovative, centralised, multidisciplinary medicines optimisation clinic for PCSK9 inhibitors

Authors
  • Khatib, Rani1, 2, 2
  • Khan, Mutiba2
  • Barrowcliff, Abigail2
  • Ikongo, Eunice2
  • Burton, Claire2
  • Mansfield, Michael2
  • Hall, Alistair1, 2
  • 1 University of Leeds, Leeds, UK , Leeds
  • 2 Leeds Teaching Hospitals NHS Trust, Leeds, UK , Leeds
Type
Published Article
Journal
Open Heart
Publisher
BMJ
Publication Date
Apr 06, 2022
Volume
9
Issue
1
Identifiers
DOI: 10.1136/openhrt-2021-001931
PMID: 35393352
PMCID: PMC8991064
Source
PubMed Central
Keywords
Disciplines
  • 1506
License
Unknown

Abstract

Background Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is) are an important but underutilised option to help optimise lipid management. We developed a new service to improve patient access to these medicines in line with National Institute for Health and Care Excellence recommendations. This paper describes the model and provides lipid-lowering results and feedback from the first 100 referred patients. Methods The service is based on a centralised multidisciplinary clinic that is the sole prescriber of PCSK9i therapy in the area. Referred patients are assessed for eligibility and given tailored, person-centred support, education and monitoring to promote treatment adherence and lipids optimisation. The clinic also supports referred patients that do not meet PCSK9i eligibility criteria. Results Among the first 100 patients referred (n=62 male; mean age: 62.9±10.5 years), 48 were initiated on PCSK9i therapy. Mean total cholesterol decreased from 7.7±1.6 mmol/L at baseline to 4.5±1.4 mmol/L at 3 months (41% reduction), while mean low-density lipoprotein-cholesterol (LDL-C) fell from 5.0±1.6 mmol/L to 2.1±1.3 mmol/L (58% reduction; p<0.0001) and median LDL-C decreased from 4.8 mmol/L to 1.6 mmol/L (67% reduction) over the same period. These decreases were maintained at 12 months (45%, 65% and 67% reductions, respectively; p < 0.0001 for the decrease in mean LDL-C from baseline). Patient feedback on the clinic was positive and overall satisfaction was high. Conclusions This innovative, person-centred, multidisciplinary service successfully initiated PCSK9i therapy for eligible patients and drove long-term monitoring, adherence and cholesterol lowering. It also provided medicines optimisation and adherence assistance to PCSK9i-ineligible patients. The model could be used in other areas to support better uptake and optimisation of PCSK9i therapy.

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