PrescQIPP

Legacy Lipid Therapy, scrutinised for safety by specialised centralised pharmacy team

Nottingham West Primary Care Network

Project summary

This project uses a central specialist team of pharmacists to proactively phone patients from all 12 member practices of the Primary Care Network (PCN) who are currently prescribed suboptimal lipid lowering therapy including simvastatin 80mg, simvastatin and Calcium Channel Blockers (CCB) and omega 3 medications. Maintenance for ongoing identification is then run as a batch report across the PCN to ensure monthly timely proactive monitoring reviews, ensuring equality across the PCN for our patients.

The MHRA advises that simvastatin carries known risks of muscle damage (myopathy) with the highest risk linked to an 80mg dose. It also requires strict dose limitations when taken with certain other medications. (1,2)

The MHRA also published safety information in 2024 after a European review of omega 3 prescribing identified a dose-dependent increased risk of atrial fibrillation with patients with established cardiovascular disease or cardiovascular risk factors, particularly highest at a daily dose of 4g (3)

Main outcomes

Simvastatin 80mg:

  • 11 patients identified newly prescribed simvastatin 80mg over last 12 months

  • 55% (6) of which prescribed simvastatin 40mg were taking 2 daily (total dose 80mg daily)

  • 91% (10) patients had their dose reduced or switched to an alternative medication

  • 1 patient remaining, informed decision to continue, no myopathy and LDL at target

Simvastatin and Calcium Chanel Blockers

  • 5 pts prescribed simvastatin 40mg and CCB

  • 100% (5) patients reviewed and switched by cardiology team to reduce simvastatin to safe level of maximum 20mg daily or switched to alternative safer statin e.g. Atorvastatin.

Omega 3

  • 77% of patients were deprescribed omega 3

  • 13% of patients were identified as having AF and treatment stopped

  • 6.5% of patients reported palpitations

  • At least £6000 saved on drug costs alone.

The proactive use of a specialised team to phone patients at risk was shown to be a highly effective method to ensure safe prescribing through shared decision making, resulting in improved patient outcomes and cost savings for the NHS.

Open prescribing demonstrates a potential saving of £423, 841 if all ICB locations prescribed to the current England median. (4)