Embedding pharmacist-led lipid optimisation clinics in cardiac rehabilitation

Cardiovascular disease (CVD) remains a leading cause for morbidity and mortality in the UK, accounting for one-quarter of all deaths^​1​. There is widespread undertreatment for the condition, with many patients not receiving optimal secondary prevention despite clear national guidance. Lipid management, particularly lowering low-density lipoprotein cholesterol (LDL-C), is critical but often under-addressed. 

Guidance from the National Institute for Health and Care Excellence (NICE), published in 2023, highlights that lipid management in people with established CVD remains suboptimal; effective secondary prevention strategies, including pharmacotherapy and patient education, are crucial to reduce further cardiovascular risk^​2​. 

Cardiac rehabilitation is a programme offered to patients recently diagnosed with acute coronary syndrome (ACS) within a secondary care setting. The programme covers exercise, patient education and risk factor management to promote a healthy heart recovery. Programme locations can exist within a hospital environment or in community centres. Practice can vary between each cardiac rehabilitation provider in the country and not every programme includes up-titration of secondary prevention therapy or lipid profile monitoring.  

Recognising this gap, Coventry and Warwickshire Integrated Care System (ICS) launched a pilot project, funded through a non-commercial agreement with Novartis, which embedded a pharmacist clinic across the three cardiac rehabilitation providers within the ICS to streamline lipid optimisation in ACS patients. 

From January 2024, a weekly pharmacist-led clinic at each cardiac rehabilitation provider was set up. Patients engaging with cardiac rehabilitation were provided with a blood form as standard to repeat their lipid profile 6–12 weeks after their index event. A pharmacist reviewed these results, triaging patients with sub-optimal lipid profiles and extending an invitation to them to review their medication. 

During appointments, the pharmacist reviewed medications adherence, side effects and opportunities for optimisation. LDL-C targets were set at <1.8mmol/L for patients, in line with quality and outcomes framework guidance at the time; however, some patients were given an individualised target of <1.4mmol/L where appropriate. Patients who had declined the exercise component of the programme were also approached with the offer of a pharmacist review of their medications, with the aim to provide individualised risk factor optimisation. 

Implementation faced challenges; despite service provision being in the ICS, there were multiple IT systems to navigate, which posed as barriers to being able to seamlessly access patient data to support clinical decision making.

In South Warwickshire, the geographical spread of the region meant access to phlebotomy tests were limited; therefore, patients often had a long wait to be able to access blood testing facilities. Point-of-care testing was explored for this region; however, practical constraints such as training requirements, storage of equipment and workflow integration ultimately rendered it an unviable option for the cardiac rehabilitation provider.  

Over a 12-month period, 1,461 patients across the ICS were diagnosed with an ACS event and referred to a cardiac rehabilitation provider, of which 1,074 (73%) took up the exercise component. A total of 534 pharmacist appointments were issued, and 500 (94%) patients attended their appointments. Of this number, 276 (55%) patients had changes to their lipid lowering therapy: ranging from dose changes, escalation of therapy or changing statin.

After their review, patients were discharged back to primary care to follow up with a repeat lipid profile in line with NICE guidance. As of August 2025, 198 (71%) patients of the 276 patients had a retest of their lipid profile, of which 138 (70%) patients were to target LDL-C. Within this cohort, 137 patients attended a pharmacist review, where they had not previously engaged with the exercise programme. 

Inclusion of a pharmacist was met with positive feedback from both healthcare professionals and patients alike, with many agreeing this was a valuable addition to the service. 

Early data from the National Audit of Cardiac Rehabilitation quarterly report, published in July 2024, showed an average of 82% of patients from two regional providers achieved an LDL-C of <2mmol/L following completion of their programme^​3​. Preliminary data estimate a 2.6% reduction in emergency readmissions system wide, further highlighting that a system-wide approach is essential to optimise population health and reduce health inequalities. 

The value and benefit of these interventions will be seen in the years to come, and we anticipate seeing reduced hospital admissions for acute events, such as heart attacks or stroke. Next steps include developing a business case to establish an integrated pharmacist-led clinic model as standard care across the ICS. The goal is to continue expanding the scope to encompass holistic management of cardiovascular renal-metabolic conditions within the clinic, such as blood pressure, cholesterol and diabetes to fully optimise patient care in line with the government’s NHS ten-year plan^​4​.

The success of this project provides a scalable framework for other regions, supported by similar promising initiatives nationwide.