Keywords: Triglycerides, residual risk, ASCVD, population health

Background:

ASCVD presents a considerable challenge for the devolved nations of the UK, particularly in rural areas characterised by high levels of health deprivation. In response to this issue, a rural Primary Care Network (PCN) launched a project, serving approximately 39,000 patients, many of whom are at a significantly higher risk of ASCVD events compared to the national average. The PCN rapidly identified an unmet need. Research indicates that even patients with well-controlled low-density lipoprotein cholesterol levels (with a mean LDL-C of 1.73 mmol/L, below current national targets) still face a 35% likelihood of experiencing subsequent events. To address this continued risk, residual risks such as triglycerides (TGs) require review, as their treatment can contribute to an additional 30% reduction in risk. We aimed to realise the potential benefits of decreasing morbidity and mortality associated with ASCVD, as well as reducing the burden on the NHS and wider society.

Aim of the case report:

The aim is to mitigate the care gap for patients with ASCVD by identifying eligible individuals and improving their treatment outcomes. The PCN utilised the National Institute for Health and Care Excellence (NICE) criteria to delineate the target population and implemented real-world clinical initiatives across four medical practices.

Case report:

Each practice utilised different approaches, such as Nurse-Led Clinics and dedicated Patient slots, but all achieved success in optimising TG residual risk. We reviewed and optimised 718 patients, addressing the challenge of non-fasting triglycerides in Primary Care through a pragmatic approach endorsed by our Professors of Cardiology and the ICB. By treating patients as individuals and responding with kindness, we observed increased compliance and improved outcomes, which also enhanced staff morale.

Conclusions:

ASCVD is common in older adults, and improving outcomes requires a multi-faceted approach. Achieving better risk reduction requires comprehensive management, enhanced adherence, and a bespoke patient-centric approach for population risk management.