{
  "abstract": "Background Cardiometabolic disease remains the leading cause of premature morbidity and mortality in the UK. Many high-risk conditions, including hypertension, hyperlipidaemia, chronic kidney disease, and atrial fibrillation, are frequently asymptomatic and under-detected in routine care. Innovative delivery models are needed to improve systematic identification, investigation, and optimisation of treatment in primary care populations.Methods A structured 7-month cardiometabolic fellowship programme was delivered across four cohorts between 2022 and 2020, involving 202 healthcare professionals from over 30 primary care networks. The programme supported clinicians to undertake targeted clinical improvement activity within routine care pathways, focusing on case-finding, diagnostic testing, medicines optimisation, coding accuracy, and referral to specialist services.Results Across four years, fellows reviewed 7,281 patient records and contacted 10,067 patients. This led to 3,150 diagnostic investigations, 1,209 coding updates, and initiation or optimisation of pharmacological treatment in 1,498 patients. In addition, 144 patients were referred for specialist assessment ( table 1). Clinical activity spanned multiple cardiometabolic domains, including hypertension, lipids, diabetes, chronic kidney disease, atrial fibrillation, obesity, and heart failure.Conclusions Participation in a structured cardiometabolic fellowship was associated with substantial patient-level clinical activity, including improved risk identification, diagnostic accuracy, treatment optimisation, and appropriate specialist referral. These findings demonstrate that targeted support to primary care clinicians can translate into meaningful clinical impact at scale, with potential implications for population cardiovascular risk reduction.Abstract 263 Table 1AFFHHTNDiabetesLipidsCKDObesityCOPDTotalReviewed notes563342042450228118600517281Contacted2022033825591565199904010067Coded00281132277680511209Tested32003793474720120403150Consultations122685045565148627202032Treated with medication373277887018315151498Lifestyle advice15042215714311220775Referred to specialist431025151410144",
  "authors": [
    {
      "affiliations": [
        "Heath Innovation Network, London, UK"
      ],
      "name": "N Stowell"
    },
    {
      "affiliations": [
        "Heath Innovation Network, London, UK"
      ],
      "name": "S Atta"
    },
    {
      "affiliations": [
        "Heath Innovation Network, London, UK"
      ],
      "name": "L Manning"
    },
    {
      "affiliations": [
        "Heath Innovation Network, London, UK"
      ],
      "name": "O Brady"
    },
    {
      "affiliations": [
        "Heath Innovation Network, London, UK"
      ],
      "name": "R Watson"
    },
    {
      "affiliations": [
        "Heath Innovation Network, London, UK",
        "Kingston Hospital NHS Foundation Trust",
        "Imperial College London"
      ],
      "name": "R Jogiya"
    },
    {
      "affiliations": [
        "Guy’s and St Thomas’ NHS Foundation Trust"
      ],
      "name": "A Wierzbicki"
    }
  ],
  "title": "263 A structured cardiometabolic fellowship programme to improve identification and management of cardiometabolic risk in primary care",
  "uid": "ca40da93-10c2-539a-ba20-ab84aea5eaa9"
}