Lipid optimisation of CVD patients in the Black Country (2025)

Black Country Integrated Care Board

Project summary

To address high cardiovascular disease (CVD) morbidity in the Black Country, a targeted lipid optimisation programme was launched by the BCICB. Through a local prescribing incentive scheme and System Transformation Fund support, primary care teams received tailored training and tools to improve cholesterol management, particularly in deprived and ethnically diverse areas.

Interactive dashboards, outreach education, and clinical decision aids empowered practices to optimise treatment and reduce health inequalities. As a result, BCICB improved secondary prevention cholesterol target compliance from 12.55% to 48.05%, surpassing national targets and establishing itself as the most improved ICB nationally in this domain.

The initiative was started in 2023/24 with a prescribing incentive scheme aiming to optimise NHDL-cholesterol levels in post-ACS patients, and across the Black Country an increase in achieving NHDL-C targets from 33.12% (9,416 patients) at Baseline to 46.05% (12,814 patients) by Q4.

The initiative was extended in 2024/25 to include CHD, Stoke/TIA and PVD patients, and the numbers of patients achieving NHDL-C targets increased from 42.67% (17,983 patients) at Baseline to 49.52% (20,930 patients) at Q4.

This equates to 6345 additional patients reaching guideline-recommended cholesterol levels across two years — a significant population-level gain in secondary CVD prevention. Although the exact amount of event rate reduction is difficult to quantify accurately, it is likely to be significant given the high baseline event rate for the population and characteristics that make it particularly venerable to CVD- leading to a greater absolute benefit from this intervention. The number of CVD events averted will run into the thousands over the next ten years, with reduction in costs associated with reduced emergency admissions, lower long-term disability costs, rehabilitation costs, and avoided repeat care. There are also likely to be additional savings with regards societal costs. This effect is amplified when the premature and preventable nature of CVD are considered.

We are now the most improved ICB nationally for patients with recorded CVD who have achieved the recommended cholesterol target. This demonstrates the impact of focused efforts in lipid management and optimised prescribing practices and is testament to the hard work undertaken by primary care in recent years.