An ACNAP survey assessing the cardiology multidisciplinary learning needs to support lipid management

Abstract Background/ Introduction: Reducing LDL cholesterol is a high priority in cardiovascular care but requires knowledge and skills to deliver effectively. Nurses and allied professionals (NAPs) can play a major role in supporting lipid optimisation. Most NAPs will work together with patients prescribed lipid lowering therapies, and some may be more closely involved in initiation and monitoring. The Association of Cardiovascular Nursing and Allied Professionals (ACNAP) wanted to gauge the level of understanding, confidence and learning needs of cardiology professionals to better implement European Society of Cardiology (ESC) lipid lowering guidelines. Purpose The aim of the project was to highlight gaps in knowledge to better inform needs for training and educational programmes developed by ACNAP. Methods A 29 question electronic survey was developed by expert consensus, exploring previous experience, clinical knowledge, and perceptions of learning needs. It was launched at the EuroHeartCare conference in June 2023, on social media, and members of the ESC were emailed inviting participation. Results 123 people responded. 29.5% of the respondents were physicians and 70.5% NAPs. Most respondents were involved in lipid optimisation of some description with only 7.0% of respondents having no direct involvement in their patient cohort. A higher percentage of respondents responded "totally agree" when asked it they knew what cholesterol targets to aim for in secondary prevention, compared to primary prevention (61% v 41.5%). 94% of respondents felt comfortable when to initiate statins and and 82% ezetimibe. This reduced to 45% for inclisiran and 40% for bempedoic acid. Similarly, the majority felt comfortable counselling a patient newly initiated on statins or ezetimibe, but significantly fewer the newer lipid lowering therapies. Experience and understanding of familial hypercholesterolaemia (FH) was also explored. Only half the respondents would be comfortable in identifying and diagnosing FH and a further 25% unsure. A large percentage (37%) were unaware of the Simon Broome criteria or the Dutch Lipid Criteria Network (49%). When considering learning needs, 71% of NAP respondents needed extra support to help make lipid lowering decisions. This rises to 84% and 74% when looking at nurses and pharmacists separately, respectively. Nearly 76% would prefer any learning to be delivered online, with interactive online training packages being the most popular method. Conclusions The three main gaps identified by NAPs were: management in primary prevention (initiation and targets), the newer innovative medicines (bempedoic acid, inclisiran and PCSK9 monoclonal antibodies) and FH. Interestingly, these are the same gaps highlighted by physician responders. These findings can help guide ACNAP and ESC in the development of educational programmes with the aim to improve better lipid management overall.