Lipids, Familial Hypercholesterolaemia (FH) and PCSK9i Guide for SystmOne

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:

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 :