Searches:
Searches beginning “!” or “?” are key reports for clinical teams to consider running. These can be found by sorting the searches by name.
A suite of searches for SystmOne, created by the Clinical Digital Resource Collaborative (CDRC) can be used to identify patients to review with regards lipid optimisation and identification of patients with possible FH. Searches are organised into tiers to allow for manageable numbers of patients depending on the resource you have available. To find out more, please visit the facts.cvd website.
Tiers 1 & 2: Lipids Optimisation
- People who need their lipid therapy to be considered for very high intensity
- People prescribed a statin but not taking it
- People with a history of a previous CVD event i.e. for secondary prevention but not prescribed lipid lowering therapy
- Those with a CVD risk greater than 20% who have not had a risk assessment
- People with a Q-risk greater than 10% but not prescribed lipid lowering therapy
- People with an estimated QRISK >10% who are not currently eligible for NHS Health Check and do not have a Long Term Condition (LTC).
Tier 3: FH
- People with suspected FH
- People who may need specialist lipid input such as requiring a PCSK9 inhibitor or potential contra-indication regarding statin therapy.
Please contact contact-CDRC@ahsn-nenc.org.uk to register your interest, and if you need help with searches/ templates.
SystmOne Guidance: Lipids & Familial Hypercholesterolemia:
The information below is designed to support users to access CDRC searches and reports via SystmOne in line with the facts.cvd Standard Operating Procedure. For additional guidance, please watch the tutorial video below.
The following sets of searches will help identify patients with uncoded conditions which will affect decisions about lipid modification.
Case Finding (Cardiology) – uncoded CHD, AF
Case Finding (Renal) – uncoded CKD
Case Finding (Neurology) – uncoded stroke / TIA or unclassified stroke types
Case Finding (Vascular) – uncoded PAD
The following report may also identify patients with uncoded atherosclerotic disease:
CDRC Quality > Cardiovascular>? Drug to Diagnosis 003 – Antiplatelets without obvious indication
The following searches will identify people who might benefit from lipid modification based on information in the record which suggests they have a clear indication.
| Search | Location | Notes | |
| ? LIPID 3.0 Management – Consider Lipid Lowering # | CDRC Quality – Lipids | Patients who appear eligible for lipid lowering for primary or secondary prevention who haven’t got a recorded reason why not. | Review patient – consider offering statin, recording ‘declined, not indicated’ etc, recording previous ADRs to lipid lowering treatment. This search has child searches which risk stratify patients so those at highest risk can be prioritised (3.01-3.06) |
Patients in LIPID 3.0 will have the following patient status alert to prompt the clinician to consider discussing statins.
Clicking the PSA will open the Lipid Details template.
They will also have a prompt to consider lipid lowering on the LTC management system and a prompt to consider checking LFTs/lipids if the patient would consider lipid lowering.
The following search will identify people who do not appear to be taking lipid lowering medication which is on repeat
| Search | Location | Notes | |
| ? Lipids 3.2 Management – Possible poor lipid lowering therapy concordance # | CDRC Quality – Lipids | Patients with repeat lipid lowering therapy who have not been issued a prescription in the last 3 months | Review patient – discuss concordance or remove medication from repeat if no longer necessary |
The LTC Master template and Lipid Details template will display a warning about concordance.
The Medication Timeline and Lipid Results with Lipid Rx buttons can be used to examine concordance in more detail
The following searches will identify patients who may need lipid modification optimisation
| Search | Location | Notes | |
| ? Lipids 4.1 Management – On lipid lowering – without a lipid target # | CDRC Quality – Lipids | Patients with repeat lipid lowering therapy who do not have a lipid target | Review patient – consider adding target. The Lipid Details Template will facilitate this |
| ? Lipids 4.2 Management – On lipid lowering – has lipid target but not achieved # | CDRC Quality – Lipids | Patients with a lipid target which has not been achieved | Consider intensification of lipid treatment or relaxation of target (e.g. for frail patients) |
| ? Lipids 4.3 Management – On low/mod lipid lowering – consider intensification # | CDRC Quality – Lipids | Patients on moderate or low potency lipid lowering without a documented reason. | Review patient. Consider: – Intensification – coding of previous ADRs to lipid lowering – recording patient has reached maximally tolerated lipid lowering. – Loosen target cholesterol |
| ? Lipids 4.31 Management – On low/mod lipid lowering – consider intensification (excl. target is achieved) | CDRC Quality – Lipids | As for 4.3 but excludes patients who have reached their target cholesterol | As above |
| ? Lipids 4.4 Management – Consider intensification to very high intensity lipid lowering # | CDRC Quality – Lipids | Patients eligible for secondary prevention who are not on very high intensity lipid lowering | Review patient. Consider – Intensification – coding of previous ADRs to lipid lowering – recording patient has reached maximally tolerated lipid lowering. – Loosen target cholesterol |
| ? Lipids 4.41 Management – Consider intensification to very high intensity lipid lowering (excl. target is achieved) # | CDRC Quality – Lipids | As for 4.4 but excluding patients who have reached their target cholesterol | As above |
| ? Lipids 4.5 Management – Consider intensification for patients with ASCVD and non-HDLC >=2.5 | CDRC Quality – Lipids | Patients with established atherosclerotic ASCVD with nonHDL C unless they have achieved a stated target | – Review patient. Consider – Intensification coding of previous ADRs to lipid lowering – recording patient has reached maximally tolerated lipid lowering. – Loosen target cholesterol |
Patients found in searches 4.1, 4.2, 4.3 and 4.4 will have prompts displayed on the Lipid Details and LTC Master template:
The following searches will identify patients who may need more specialist input
| Search | Location | Notes | |
| PCSK9i Treatment | |||
| ? Lipids 5.1 Management – Consider lipid lowering – May need more detailed input | CDRC Quality – Lipids | Patients who appear to need lipid lowering but have had ADR to at least one statin AND ezetimibe – may need specialist input | |
| ? Lipids 5.2 Management – Referral criteria for PCSK9i but poor concordance with current treatment | CDRC Quality – Lipids | Fulfil referral criteria for PCSK9i therapy but may not be taking current lipid lowering therapy | Review concordance |
| ? Lipids 5.3 Management – Referral Criteria for PCSK9i – Consider primary care intensification | CDRC Quality – Lipids | Fulfil referral criteria for PCSK9i therapy but there may be scope for intensification of lipid lowering therapy in primary care | Review record |
| ? Lipids 5.4 Management – Referral Criteria for PCSK9i – Consider referral ** | CDRC Quality – Lipids | Likely to be eligible for PCSK9i referral | Consider referral |
| Familial Hypercholesterolaemia | |||
| ? Lipids 2.0 Case Finding – Consider screening for familial hypercholesterolaemia ** | CDRC Quality – Lipids | Patients at high chance of having familial hypercholesterolaemia | Review record |
** Patients will be excluded from these searches for 5 years is the questionnaire on the lipid review is completed.
Patients in 5.4 will have a prompt displayed on the Lipids Details and LTC Master templates:
NICE guidance indicates that patients with an estimated CVD risk >=10% (i.e. based on the information currently available in the record) should be offered a formal CVD risk assessment. The following searches identify such patients
| Search | Location | Notes | |
| ? Lipids 1.0 Screening – Target for CVD Risk Assessment (as estimated risk is >10%) | CDRC Quality – Lipids | Patients whose estimated CVD risk is >10%. Excludes: – On lipid lowering therapy – Recorded reason why lipid lowering therapy not being taken – Established CVD or FH | Consider offering these patients a CVD risk assessment |
| ? Lipids 1.01 Screening – Target for CVD Risk Assessment – eligible for NHS HC | CDRC Quality – Lipids | Patients in 1.0 who are currently eligible for and NHS Health Check | Consider offering NHS Health Check |
| ? Lipids 1.02 Screening – Target for CVD Risk Assessment – has LTC | CDRC Quality – Lipids | Patients in 1.0 who also have a long term condition | Consider offering CVD risk assessment at next LTC review |
| ? Lipids 1.03 Screening – Target for CVD Risk Assessment – not eligible for NHS HC, no LTC | CDRC Quality – Lipids | Patients in 1.0 who do not have a long term condition and who are not currently eligible for an NHS Health Check | Consider specific invitation for CVD risk assessment |
| ? Lipids 1.04 Screening – Target for CVD Risk Assessment – estimated risk >20% | CDRC Quality – Lipids | Patients in 1.0 who have an estimated CVD risk >=20% | Consider prioritising these patients for CVD risk assessment |
Additional Information
The main lipids template gives an overview of all relevant results, medication history, patient decision aids and quick-access buttons to record frequently-required actions:
The ‘Meds Overview’ button gives a timeline of medications so the clinician has an overview of what the patient has had before, what they are on now and concordance:
The template links to a QRISK2 Calculator which populates based on the patient’s medical record:
![QRISKS2 (2015) Calculator
The product is intended to aid and supplement not substitute for, the expertise and judgement of physicians,
pharmacists or other healthcare professional. All information is provided on the basis that the healthcare
practitioners responsible for patient care will retain full and sole responsibility for deciding any treatment to
prescribe or dispense for all patients and, in particular whether the use of information provided by the product
is safe, appropriate, or effective for any particular patient or in any particular circumstance.
Patient Data
systolic ap
Postcode
Total / HDL cholesterol ratio
Ethnicty
• Male
31 02
NEI ISG
o
Female
mmHg
Kghmz
White/Not Stated
Medical History
Smoking status Non smoker
Diabetes category Not diabetic
Family history of premature coronary heart disease
Treated for hypertension
Atrial fibrillation
Z] Rheumatoid anhrtis
Chronic renal disease
Z] Personal history of CVD
Patient has a history ot CVD making the calculation invalid.
Cholesterol ratio not recorded, so will use calculated default of This will generate an estimated scor4
Invalid Estimated 10yr QRlSK@2 Score: 3.02%
Save to Record
Statins 1 Selection Reasons](https://cdrc.nhs.uk/wp-content/uploads/2020/08/image-2.png)
There is also a link to Dr Chris Cates’ EBM Website to plot a Cate’s plot for shared decision making with the patient:
The template also helps the clinician to generate and send patient information leaflets:
A protocol can be run from the template to calculate Target Non-HDL Cholesterol:
The following patient status alerts help flag up to the clinician that a patient may need a review of their lipids or to conisder starting a statin:
The following searches give an overview of lipid management/performance:
The searches are based on a ‘pyramid’ model (each level mutually exclusive):
- Established CVD
- Familial Hypercholesterolaemia (FH)
- Primary prevention indicated e.g. qrisk >=10%, CKD
- People who should be targeted for CVD risk assessment (often NHS health check but many of these patients are not eligible for a HC)
For each level you are given the size of the population – in the example above you can see that 6.2% of the pop have CVD, 0.5% have FH (excluding those with CVD), 19.1% are definitely eligible for primary prevention with lipid lowering, 2.3% of the population should be targeted for cvd risk assessment as their estimated risk based on the information in the record suggests their actual risk is >=10%.
For each level you are given the performance e.g. 60.4% of patients who are eligible for primary prevention are prescribed it. 70.3% are on lipid lowering or there is a good reason why not e.g. multiple adverse reactions to statins, has said they don’t want it in the last year.
For each level there are also searches to find the ‘missed’ patients. E.g. missed PAD coding, wrong stroke codes, missed CKD coding etc.
The following search can find patients in your population who may have poor lipid-lowering medication concordance:
The following searches are complex and identify patients who:
- Might have undiagnosed FH
- Have a genetic or clinical diagnosis of FH
- Have had the Dutch Lipid Clinic Network Score (DLCNS) calculated (proxy for ‘have been fully assessed’), or those referred to lipid clinic.
The searches were created by working with lipid specialists to develop resources to compare all the FH detection tools: NICE, Simon Broome, DLCNS, and Famcat. The searches were then refined to improve accuracy e.g. adding LDL and non-HDL criteria to the NICE criteria, adjusting for high triglycerides. Specialist Lipid Nurses then reviewed the patients identified and decided who needed further assessment and/or genetic testing. This information was used to develop search strategies which can adjust sensitivity and specificity. The chosen search strategy for the National FH Programme is:
- Estimated DCLNS of 5 or more (adjusted for high triglyceride levels) OR
- Patients with NICE Plus criteria for FH (adjusted for high triglyceride levels) NICE PLUS includes LDL-C and NON-HDL-C as well as TC.
The following searches can help identify patients who meet referral criteria for PCSK9i :
Video Demonstration
Please see below for a video demonstration of the resources in action on SystmOne:
Get in touch
If you have any questions regarding access, or the use of the CDRC Precision tools, please get in touch: contact-CDRC@ahsn-nenc.org.uk