44 Introduction of a lipid multidisciplinary team meeting to improve outcomes for individuals attending cardiac rehabilitation in aneurin bevan university health board

<h3>Background</h3> Cardiac rehabilitation (CR) has a role in managing lipids for secondary prevention of cardiovascular disease, identifying patients with dyslipidaemias, and facilitating referrals to specialised Lipid Clinics. Long waiting times delayed treatment, therefore a Lipid Multidisciplinary Team (MDT) was introduced. <h3>Aim</h3> To streamline the patient pathway for those requiring specialist lipid services to increase clinic capacity; timely management of elevated low-density lipoprotein cholesterol (LDL-C) on CR programmes; improve knowledge of CR clinical nurse specialists (CNS); identify patients with elevated lipoprotein (a) (LP(a)) and recommend family screening in Primary Care. <h3>Methods</h3> A virtual 4-weekly MDT meeting was established, attended by CR CNSs, Consultant Chemical Pathologist, FH Specialist Nurse, and Clinical Fellow in Biochemistry. Patients attending rehabilitation between November 2021 and July 2023 had their lipid profile assessed and 290 were discussed at MDT. A mean of 11 patients were discussed per month (standard deviation 3.23). Staff completed a self-assessment of confidence to manage lipids prior to MDT and at end of project. <h3>Results</h3> In total, 290 patients were reviewed: 117 referred to Lipid Clinic; 173 underwent LP(a) testing and medical optimisation on CR. There was a 60% reduction in referrals to specialist lipid clinic, and the 6-12 month waiting time avoided. The MDT facilitated access to PCSK9i clinic, where treatment initiation occurred within 8 weeks. Additionally, analysis of NACR data revealed a reduction in mean LDL-C levels following the MDT’s introduction. Staff survey highlighted positive associations between MDT attendance and CNS confidence in lipid management. <h3>Conclusion</h3> The Lipid MDT achieved its aims and impacted beyond the clinic; anecdotal evidence indicates that guidance is sought more regularly by GPs to help manage patients with elevated LP(a). A comprehensive audit to assess LP(a) testing and communication with high-risk relatives is essential to determine the broader effect of lipid MDT on cardiovascular risk management.