Pilot treatment pathways in the Vendée and Loire-Atlantique for familial Hypercholesterolemia

12 December 2017

Structure of the treatment pathway for patients affected by familial hypercholesterolemia implemented in the departments of Loire-Atlantique and the Vendée

Familial hypercholesterolemia (FH) is one of the most common genetic diseases and is responsible for a marked increased in cardiovascular risk. However, many healthcare professionals remain unaware of it, and it can be poorly detected or missed in spite of the existence of prevention and treatment measures.

Based on these observations, the Nantes University Hospital therefore created a treatment pathway optimisation project for FH patients in the two pilot departments, the Vendée (85) and Loire-Atlantique (44), with the help of various partners.

The action plan, discussed during multi-disciplinary consultations jointly involving healthcare professionals and patients, led to the implementation of various actions from August 2015. These are aimed at raising patient and healthcare professional awareness of FH, as well as improving screening and treatment for this condition, especially through:

  • The implementation by biologists of a specific warning system to the possible existence of FH on the records of patients with high levels of LDL-cholesterol (or bad cholesterol)
  • Information for General Practitioners, endocrinologists and cardiologists, both in hospitals and private practices, with a proposed treatment pathway
  • Creation of a genetics advisor/treatment pathway coordinator post in the endocrinology service, working with the Nantes University Hospital genetics service to facilitate family studies and cascade screening of relatives.

The impact of this programme aimed at structuring treatment pathways, measured 15 months after its implementation in the pilot French departments, was more than positive, with (1) a significant improvement of the diagnostic incidence of FH, in particular in relatives, and (2) a trend towards improved control of LDL-cholesterol in affected patients. Areas for improvement were also identified, in particular links between towns/cities and hospitals.

This work was the subject of a poster presented to the annual NSFA Congress in June 2017.

The Nantes University Hospital Endocrinology service has worked with the Nouvelle Société Française d’Athérosclérose (New French Society of Atherosclerosis), the Unions Régionales des Professionnels de Santé (URPS – Regional Unions of Health Professionals) biologists and pharmacists. Médiation Conseil Santé oversaw the project’s development, which was assessed by Public Health Enterprise. The project received institutional support from the Amgen laboratory.