• Skip to main content
  • Skip to secondary menu
  • Skip to footer
Clinical Digital Resource Collaborative

Clinical Digital Resource Collaborative

Designed and developed in the North East and North Cumbria by local GPs

National Health Service
  • Home
  • About Us
  • The Team
  • Resources
    • Referral Forms
    • EMIS Resources
      • CDRC EMIS Access
      • Long Term Condition (LTC) Management
      • Impact and Investment Fund (IIF)
      • Medicine Management
        • Precision Monitoring
        • DMARDs and High Risk Drugs
        • Safe Prescribing of Opioids / Opiates
      • Specialties
        • Cancer Guide for EMIS
        • EMIS Cardiovascular Overview
          • Atrial Fibrillation Guide for EMIS
          • CDRC Precision CVD Prevention Template
          • Lipids, Familial Hypercholesterolaemia (FH), PCSK9i & Inclisiran Guide for EMIS
          • Peripheral Arterial Disease EMIS Guide
        • Infection
          • Infections Guide for EMIS
          • Blood Borne Virus (BBV)
        • Neurology Guide for EMIS
        • Respiratory Overview
          • BeatAsthma+
    • SystmOne Resources
      • National Early Warning Score 2 (NEWS2) Guide for SystmOne
      • Getting Started
        • Getting Started – Access
        • Getting Started – How-To’s
      • SystmOne Administration
      • Contract Management
        • Impact and Investment Fund (IIF)
        • Vaccinations
      • Long Term Condition Management
        • Call/ Recall System
        • Recall Recovery System
        • Care Planning
      • Safeguarding System
        • Safeguarding Adults
        • Safeguarding At Risk of Harming Others
        • Safeguarding Family/Household Cause for Concern
        • Safeguarding Children
      • Medicine Management
        • Drugs Requiring Monitoring System
        • Safety & Reviews
        • Safe Prescribing of Opioids / Opiates
        • Safe Prescribing of NSAIDS
        • Safe Prescribing of Lithium
        • Safe Prescribing of Valproate
        • Safe Prescribing of Corticosteroids / Steroids
      • Specialties
        • Blood Borne Virus (BBV) Test Alert for SystmOne
        • BeatAsthma+ Guide for SystmOne
        • Cancer Overview
          • Cancer
          • Suspected Cancer
        • Cardiovascular Overview
          • Cardiology Results
          • Hypertension & Blood Pressure
          • Atrial Fibrillation (AF)
          • Integrated CVD Prevention
          • Peripheral Arterial Disease (PAD)
        • SystmOne Diabetes Overview
          • SystmOne Diabetes Management
          • SystmOne Diabetes Prevention
          • SystmOne Diabetic Kidney Disease
        • ENT Infections
        • Geriatrics Overview
          • Care for Frail Patients
          • Comprehensive Geriatric Assessment
          • Co-ordinated Care
        • Haematology
        • Infection Overview
        • Learning Disabilities
        • Lifestyle
        • Lipids, Familial Hypercholesterolaemia, PCSK9i & Inclisiran Overview
          • Lipids, Familial Hypercholesterolaemia (FH), PCSK9i & Inclisiran Search Guide for SystmOne
          • Lipids Protocols
          • Lipids Opt-In Resources
          • Lipid Details and Lipid Lowering Templates
          • Lipid Lowering Template
          • Lipid QoF Support
          • Screening for Familial Hypercholesterolaemia
          • Aetiology of Abnormal Lipids
          • Lipids Strategy
          • Lipids – Recommended Batch Searches
        • MSK Referral Management
        • Neurology
        • Obesity Resources
        • Ophthalmology
        • Palliative Care
        • SystmOne Renal/Urology Overview
          • Chronic Kidney Disease (CKD)
        • Respiratory Overview
          • Asthma Resources
          • Respiratory Infections
        • Rheumatology Overview
          • Bone Health
      • Women’s Health Overview
        • Gynaecology Resource Overview
          • Cervical Screening
          • Contraception
          • Prolapse
      • Vaccination Overview
        • COVID-19 Resources- SystmOne
        • Influenza Vaccination
        • Meningitis B Vaccination
        • Meningitis ACWY Vaccination
        • Pneumococcal Vaccination
        • Shingles Vaccination
  • FAQs
  • News and Events
    • Demonstrations
    • Events
      • Recordings
    • Articles
    • Conference abstracts
  • Contact us
You are here: Home / Resources / SystmOne Resource Centre / SystmOne Specialties / Lipids, Familial Hypercholesterolaemia, PCSK9i & Inclisiran Overview / Lipids, Familial Hypercholesterolaemia (FH), PCSK9i & Inclisiran Search Guide for SystmOne

Lipids, Familial Hypercholesterolaemia (FH), PCSK9i & Inclisiran Search Guide for SystmOne

On this webpage, you will find information on the available CDRC Lipid Management Searches including:

  • Quality Improvement – Searches to identify patients who might benefit from lipid lowering or treatment optimisation.
  • Performance – Searches to show current performance with respect to lipid management.
  • Statin Safety – Searches to identify patients with significant statin safety issues.

Quality Improvement

The CDRC searches highlighted in this section will help to identify patients who may benefit from lipid lowering or treatment optimisation.

These searches have been organised into groups to allow for manageable numbers of patients depending on the resource you have available.

Case Finding Searches

It is recommended that you first run the searches in each of the nodes below as these will identify patients with potentially un-coded conditions that will affect decisions about lipid modification.

Case Finding (Cardiology) – uncoded CHD, AF

Atrial Fibrillation 

Search NameSearch Location  Search ReturnsNotes 
? AF 2.1 Casefinding – Medication that might be for AF but no AF code CDRC Quality > Cardiovascular Patients with chronotropic medication without any obvious reason* Also likely to lead to detection of uncoded CHD, heart failure, hypertension, Raynauds, SVT, VT 
? AF 2.2 Casefinding – AF potential indicator but no AF code CDRC Quality > Cardiovascular Patients with codes which might indicate AF such as ‘AF annual review’ or ‘CHADS score’ Check for uncoded AF and/or consider removing any erroneous historic codes. 
? AF 2.3 Casefinding – Irregular pulse but no subsequent ECG CDRC Quality > Cardiovascular Patients with a record of an irregular pulse without a subsequent ECG to check for AF Consider offering repeat pulse check and/or ECG 
? AF 2.4 Casefinding – AF marked as resolved CDRC Quality > Cardiovascular Patients who have been removed from the AF register by virtue of AF resolved Recent information suggests that patients with AF should not be removed from AF registers prematurely as they remain at higher risk of stroke. 

*reports for individual drugs can be found in the same folder called ? Drug to diagnosis 00x – xxxxx without obvious indication 

Coronary Heart Disease 

Search NameSearch Location Search ReturnsNotes 
? CHD 2.1 Casefinding – Potential CHD Indicator but no QoF code CDRC Quality – Cardiovascular Patients with codes which might indicate CHD such as ‘CHD annual review’ or ‘angina control’ Check for uncoded CHD and/or consider removing any erroneous historic codes.  
? CHD 2.2 Casefinding – Potential MI Indicator but no QoF code CDRC Quality – Cardiovascular Patients with codes which might indicate CHD such as ‘H/o myocardial infarction’ Check for uncoded CHD and/or consider removing any erroneous historic codes. 
? CHD 2.3 Casefinding – Medication that might be for CHD but no CHD code # CDRC Quality – Cardiovascular Patients taking medication indicated for CHD without any obvious reason* Also likely to detect AF, heart failure, hypertension, PAD, Raynauds, stroke/TIA, SVT, VT 

*reports for individual drugs can be found in the same folder called ? Drug to diagnosis 00x – xxxxx without obvious indication 

The following report may also identify patients with CHD as well as other atherosclerotic disease: 

CDRC Quality > Cardiovascular> ? Drug to Diagnosis 003 – Antiplatelets without obvious indication 

Heart Failure 

Search NameSearch Location Search ReturnsNotes 
? Heart Failure 2.1 – Case Finding – Significantly raised BNP w/o HF CDRC Quality – Cardiovascular Patients with a significantly raised BNP without diagnosis of heart failure Review record  
? Heart Failure 2.2 – Case Finding – LVSD/LVDD or moderately raised BNP – on loop diuretic CDRC Quality – Cardiovascular Patients taking loop diuretics  with LV systolic or diastolic dysfunction or a raised BNP Review record 
? Heart Failure 2.3 – Case Finding – Heart failure medication but no heart failure diagnosis CDRC Quality – Cardiovascular Patients taking spironolactone/eplerenone/sacubitril without obvious reason. (will detect some patients being given spironolactone for resistant hypertension)  

*reports for individual drugs can be found in the same folder called ? Drug to diagnosis 00x – xxxxx without obvious indication 

Additional patients might be found in the drug to diagnosis audits for beta-blockers and renin-angiotensin drugs 

Hypertension 

Search NameSearch Location Search Returns Notes 
? Hypertension 2.1 Casefinding – Potential Hypertension indicator but no HT code CDRC Quality – Cardiovascular Patients with codes which might indicate hypertension such as ‘hypertension annual review’ Check for uncoded hypertension and/or consider removing any erroneous historic codes.  
? Hypertension 2.2 Casefinding – Medication that might be for HT but no HT CDRC Quality – Cardiovascular Patients taking medication indicated for hypertension without any obvious reason* Also likely to detect AF, CHD, heart failure, PAD, Raynauds, SVT, VT 
? Hypertension 2.3 Casefinding – ABPM>135/85 and not appropriately coded CDRC Quality – Cardiovascular Patients with a home BP <=135/85 without a diagnosis of hypertension. Review record and add hypertension code or correct home BP if this was incorrect. 

*reports for individual drugs can be found in the same folder called ? Drug to diagnosis 00x – xxxxx without obvious indication 

Case Finding (Renal) – uncoded CKD

CKD Diagnosis 

Search NameSearch Location Search Returns Notes 
? CKD 2.1 Casefinding – Suspected CKD3-5 but not coded CDRC Quality – Renal Patients with last two eGFR readings <60 at least 3 months apart but no code for CKD3-5 Consider adding CKD code  
? CKD 2.2 Casefinding – eGFR<60 over 4 months ago but not coded with CKD 3-5 CDRC Quality – Renal Patients whose last eGFR was <60 (at least 4 months ago) without a code for CKD 3-5 Review record. Consider repeat eGFR 
? CKD 2.21 Casefinding – eGFR<50 over 4 months ago but not coded with CKD 3-5 CDRC Quality – Renal As above but eGFR <50 so more specific but less sensitive Review record. Consider repeat eGFR 
? CKD 2.3 Casefinding – Repeated ACR>3 but not coded with CKD # CDRC Quality – Renal Patient with last two ACR readings >3 without a diagnosis of CKD1-5  Consider adding CKD code 
? CKD 2.31 Casefinding – Repeated ACR>3 but not coded with CKD # CDRC Quality – Renal As above but excluding people on the diabetes renal disease QoF register  Consider adding CKD code 
Case Finding (Neurology) – uncoded stroke / TIA or unclassified stroke types

Stroke / TIA Casefinding 

Search NameSearch Location Search ReturnsNotes 
? Stroke TIA 2.1 Casefinding – Potential Stroke Indicator but no QoF Code CDRC Quality – Neurology Patients with codes which might indicate stroke/TIA such as ‘stroke annual review’ or ‘amaurosis fugax’ There are two separate reports that subdivide admin and clinical codes Check for uncoded stroke/TIA and/or consider removing any erroneous historic codes.  
? Stroke TIA 2.2 Casefinding – Vascular dementia codes without H/O stroke/TIA CDRC Quality – Neurology Many patients with vascular dementia have had cerebral infarcts Review hospital letters and scan results to look for evidence of past cerebral infarction 
? Stroke TIA 2.3 Casefinding – Unclassified stroke type # CDRC Quality – Neurology Patients with code for stroke which isn’t further classified as a haemorrhagic or ischaemic stroke Review hospital letters and scan results to look for evidence of stroke type. Replace generic stroke code with specific code 
? Stroke TIA 2.31 Casefinding – Non-classified stroke on antiplatelets or anticoagulant CDRC Quality – Neurology Patient as in 2.3 but already taking antiplatelets or anticoagulants so more likely to have had ischaemic stroke As above. 

The report following report may also identify patients with stroke as well as other atherosclerotic disease 

CDRC Quality > Cardiovascular > ? Drug to Diagnosis 003 – Antiplatelets without obvious indication 

Case Finding (PAD) – uncoded PAD

PAD Casefinding 

Search Name Search Location Search ReturnsNotes 
? PAD 2.1 Casefinding – PAD drugs but no PAD diagnosis # CDRC Quality – Neurology Patients with medication which might indicate PAD such as naftidrofuryl Check for uncoded PAD .  
? PAD 2.2 Casefinding – PAD procedure but no QoF code CDRC Quality – Neurology Patients with codes which might indicate PAD such or ‘fem-pop bypass’ Check for uncoded PAD and/or consider removing any erroneous historic codes. 

The following report may also identify patients with PAD as well as other atherosclerotic disease: 

CDRC Quality > Cardiovascular > ? Drug to Diagnosis 003 – Antiplatelets without obvious indication 


Identifying Patients for Intervention

CDRC’s Lipid Searches are located in the CDRC Quality > Lipids folder

Screening for patients at risk of CVD

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 NameSearch ReturnsNotes 
? Lipids 1.0 Screening – Target for CVD Risk Assessment (as estimated risk is >10%) 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 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 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 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% Patients in 1.0 who have an estimated CVD risk >=20% Consider prioritising these patients for CVD risk assessment 
Screening for Familial Hypercholesterolaemia

Patients who may have Familial Hypercholesterolmaemia (FH) can be identified in the following searches. Patients are identified using a combination of tools – NICE guidance, estimated Dutch Lipid Clinic Network scores and estimated Welsh FH Score with adjustment for high triglyceride levels. 

Click here for further resources to assist with FH Screening.

Search NameSearch Returns Action 
? 2.0 Case Finding – Consider screening for familial hypercholesterolamia Patients who have a significant chance of familial hypercholesterolaemia Screen for FH – see below 
? 2.01 Case Finding – Consider screening for familial hypercholesterolamia (also eligible for IFF FH referral)Patients in 2.0 who are also appear in the IIF CVD04 ‘consider for FH assessment’ denominator Screen for FH – see below 
? 2.02 Case Finding – Consider screening for familial hypercholesterolamia – highest risk patientsPatients in 2.0 who are at highest risk of FH – for areas with limited resources – concentrate on these patients Screen for FH – see below 
? 2.1 Case Finding – Eligible for IFF FH referral but FH less likelyPatients who appear in the IIF CVD04 ‘consider for FH assessment’ denominator, who are less likely to have FH Screen for FH – see below, but likely to have a secondary cause of hyperlipidaemia 
? 2.2 Case Finding –  Code for FH but not genetic code – consider need for genetic testingPatients with a code suggesting FH e.g. Possible FH who don’t have a definitive FH code Review record and consider: Adding definitive code if appropriate Referral for genetic testing Removal of code if incorrect – e.g. secondary hyperlipidaemia 
Identifying patients who are likely to need to be offered lipid modification

The following searches will identify patients who might benefit from lipid modification based on information in the record which suggests they have a clear indication.

Search NameSearch ReturnsNotes 
? Lipids 3.0 Management – Consider Lipid Lowering Patients who appear eligible for lipid lowering for primary or secondary prevention who don’t have a recorded reason why not. Review patient: consider offering statin or other treatment recording ‘declined, not indicated’ etc. Record 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 identified in the ? Lipids 3.0 search will have the following Patient Status Alert (PSA) to prompt the clinician to consider discussing statins.  

High CVO Risk - Consider Lipid Lowering 
High CVD risk but not on lipid lowering treatment

 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. 

Check 
Check LipidsA_FTs 
if would consider stati 
Check Hba lc 
Check ACR 
Consider Lipid Lowering
Identifying patients with poor concordance for lipid modification

The following search will identify people who do not appear to be taking lipid lowering medication which is on repeat 

Search NameSearch ReturnsNotes 
? Lipids 3.2 Management – Possible poor lipid lowering therapy concordance 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. 

Check FBC 
Check Hba lc 
Check ACR 
Consider Hypertension 
CONSIDER LOW LIPID LOWERING CONCORD
Calculate Target Non HDL-C 
Target Non HDL-C 
Statin offered 
Statin declined 
Statin not indicated 
NO cholesterol target recorded 
Current Lipid Medication 
Atorvastatin 20mg tablets 
2g Dec 
take 28 ta 
CONSIDER LOW LIPID LOWERING CONCORDANCE 
07 Jan 2011 statin not indicated rxallg) (SNOMED: 1343g1 005) 
A Medication Timeline 
Resu!ts Vpid 
A Expand 
Notes 
doesnt want thenm

The Medication Timeline and Lipid Results with Lipid Rx buttons can be used to examine concordance in more detail. 

ASPIRIN 
CLOPIOOGREL 
SILOENAFIL
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
take one daily 
take one daily 
take one daily 
take one daily 
take one daily 
take one daily 
take one daily 
take one daily 
take one daily 
take one daily 
take one daily 
05 Mar 2018 
04 dun 2018 
31 dui 2018 
27 Dec 2018 
23 Apr 201 g 
27 Aug 201g 
dan 2020 
13 2020 
lg Mar 2020 
16 dun 2020 
22 dui 2020 
04 sep 2020 
04 sep 2020 
04 sep 2020 
04 sep 2020 
7 Oct 2020 
07 Oct 2020 
07 Oct 2020 
07 Oct 2020 
serum HDL cholesterol level (4495) (SNOMED: 1 005681 0000001 07) 
Serum non high density lipoprotein cholesterol level [XabE1) (SNOMED: 
serum cholesterol level (SNOMED: 1 005671 0000001 05) 
serum LDL cholesterol level (44P6J (SNOMED: 1 0221 gl 0000001 00) 
Serum non high density lipoprotein cholesterol level [XabE1) (SNOMED: 
serum LDL cholesterol level (44P6J (SNOMED: 1 0221 gl 0000001 00) 
serum HDL cholesterol level (44P5J (SNOMED: 1 005681 0000001 07) 
serum cholesterol level (SNOMED: 1 005671 0000001 05) 
10061 glo 
10061 glo 
2f mmol/L 
2 mmol/L 
4f mmol/L 
1 7 mmol/L 
24 mmol/L 
21 mmol/L 
2G mmol/L 
4 F mmol/L 
Atorvastatin 20mg tablets 
Atorvastatin 20mg tablets 
take one daily 
take one daily 
23 Oct 2020 
Dec 2020
Optimising Lipid Modification

The following searches will identify patients who may need lipid modification optimisation. 

Search NameSearch ReturnsNotes 
? Lipids 4.1 Management – On lipid lowering – without a lipid target 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 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 Patients on moderate or low potency lipid lowering without a documented reason.  There is a subset search limited to people with manifest ASCVD only. 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) As for 4.3 but excludes patients who have reached their target cholesterol  There is a subset search limited to people with manifest ASCVD only. As above. 
? Lipids 4.4 Management – Consider intensification to very high intensity lipid lowering  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)  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 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 ? Lipids 4.1, 4.2, 4.3 and 4.4 will have prompts displayed on the Lipid Details and LTC Master template: 

Lipids Lipid Results 
Lipids 
Q 
QRISK2 calculator 
08 
Lipid Targets Exceptions 
NICE Lipid Pathway 
FH Screening References Lipids (legacy) 
Has manifest atherosclerosis SECONDARY PREVENTION usually recommended 
QRlSK2 
25 
16 Aug 2016 
Dec 2020 
08 Dec 2020 
8 Dec 2020 
08 Dec 2020 
8 Dec 2020 
Dec 2020 
QRlSK2 cardiovascular disease 10 year risk 25t3 % 
serum HDL cholesterol level (44P5J (SNOMED„ mmoI/L 
serum triglyceride levels (SNOMEO: 10 mmoI/L 
Serum non high density lipoprotein cholesterol mmol/L 
serum cholesterol level 10 mmoI/L 
serum LOL cholesterol level (4496) (SNOMEDL mmoI/L 
Target serum non high density lipoprotein cholest.„ mmol/l 
Lipid Targets 
Over the counter statin therapy 
Lipid Lowering Medication 
Rosuvastatin 5mg tablets og Mar take tm 
Lipid target NOT achieved 
Consider lipid lowering intensification 
Consider very high intensity lipid lowering 
(31
Core Data 
aronchiectasis 
copo 
Pulm Fibrosis 
CHO 
Hean Failure 
BP Hypertension 
PAD OCS 
Stroke Dcs 
dl 
Diabetes 
High Risk of DM 
Hypothyroidism 
NAFLD 
Epilepsy 
Dementia 
a Mental Heath 
C Palliative Care 
Is a Carer 
Check 
Year of Care 
Lipid target NOT achieved 
Consider lipid lowering intensification 
Consider very high intensity lipid lowering
May Need Specialist Lipid Management (PCSK9i, Inclisiran)

The following searches will identify patients who may need more specialist input: 

Search NameSearch ReturnsNotes 
? Lipids 5.1 Management – Consider lipid lowering – May need more detailed input Patients who appear to need lipid lowering but have had ADR to at least one statin AND ezetimibe 
? Lipids 5.2 Management – Criteria for PCSK9i but poor concordance with current treatment Fulfil referral criteria for PCSK9i therapy but may not be taking current lipid lowering therapy Review concordance 
? Lipids 5.3 Management – Criteria for PCSK9i – Consider primary care intensification 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 – Criteria for PCSK9i – Consider referral ** Likely to be eligible for PCSK9i referral Consider referral 
? Lipids 5.5 Management – Criteria for Inclisiran – But poor concordance with current treatment Fulfil referral criteria for inclisiran therapy but may not be taking current lipid lowering therapy Review concordance 
? Lipids 5.6 Management – Criteria for Inclisiran – Consider primary care intensification Fulfil referral criteria for inclisiran therapy but there may be scope for intensification of lipid lowering therapy in primary care Review record 
? Lipids 5.7 Management – Criteria for Inclisiran – Consider treatment Likely to be eligible for inclisiran treatment Consider treatment 
Familial Hypercholesterolaemia   
? Lipids 2.0 Case Finding – Consider screening for familial hypercholesterolaemia ** Patients at high chance of having familial hypercholesterolaemia See Screening for Familial Hypercholesterolaemia 

** Patients will be excluded from these searches for 5 years if the questionnaire on the Lipid review page of the Lipid Details template is completed. 

Patients in 5.4 will have a prompt displayed on the Lipids Details and LTC Master templates: 

Lipids 
Q QRlSK2 Calculator 
QRlSK2 
Lipid Targets 
NICE Lipid Pathway 
Over the counter statin therapy 
Lipid Lowering Medication 
Lipid Exceptions 
Lipid Lowering Declined 
Lipid Lowering Not Indicated 
On max tolerated lipid lowering 
Has manifest atherosclerosis SECONDARY PREVENTION usually recommended 
Has record of DEFINITE FAMILIAL HYPERCHOLESTEROLAEMIA 
CVD Risk Numeric NOT recorded 
10 Nov 2020 serum HDL cholesterol level (44P5J (SNOMECI 
1M mmol/L 
10 Nov 2020 serum triglyceride levels (SNOMEO: 10 
2Æ8 mmol/L 
10 Nov 2020 Serum non high density lipoprotein cholesterol In 5Æ mmol/L 
10 Nov 2020 serum cholesterol level (SNOMEO: 10 
7 mmol/L 
10 Nov 2020 serum LDL cholesterol level (4496) (SNOMED 
4f mmol/L 
NO cholesterol target recorded 
Rosuvastatin 20mg tablets 08 Mar ONE„ 28 tm 
! CONSIDER REFERRAL FOR PCSK9 INHIBITOR 
Consider adding lipid target 
RECORD of ADR to ezetimibe 
RECORD of ADR to statin(s) 
26 Jan 200g 
Patient on maximal tolerated lipid lowering therapy (Xad5i) (SBC 
Notes 
see letter 2004
Page 4 Home LettersjAppts 
HOC 
Core Data 3ntry% 
aronchiectasis 
copo 
Pulm Fibrosis 
CHO 
Hean Failure 
BP Hypertension 
PAD OCS 
Stroke Dcs 
Diabetes 
High Risk of DM 
Hypothyroidism 
O CKD 
NAFLD 
Page 5 
Epilepsy 
Dementia 
a Mental Heath 
C Palliative Care 
Is a Carer 
Check FBC 
Check 
Check LFTS 
Check AST 
Check GammaGT 
Check Lipids 
Check Hba lc 
Check ACR 
Year of Care 
Consider Shingles Vaccination 
Consider Frailty 
! CONSIDER REFERRAL FOR PCSK9 INHIBITOR 
Consider adding lipid target
Primary Prevention

CDRC has recently created individual sections to make it easier for those working in Primary and Secondary Prevention. Primary Prevention searches exclude patients with coded Atherosclerotic Disease.

Search NameSearch ReturnsNotes 
? Lipids 6.1 Primary Prevention – Possible poor lipid lowering therapy concordancePatients with repeat lipid lowering 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. 
? Lipids 6.2 Primary Prevention – Consider starting lipid loweringPatients who appear eligible for lipid lowering for primary and secondary prevention who don’t have recorded reason why not.Review patient: consider offering statin or other treatment recording ‘declined, not indicated’ etc. Record previous ADRs to lipid lowering treatment. 
? Lipids 6.3 Primary Prevention – Consider setting lipid targetPatients 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 6.4 Primary Prevention – Lipid target set but not achievedPatients with a lipid target which has not been achievedConsider intensification of lipid treatment or relaxation of target (e.g. for frail patients). 
? Lipids 6.5 Primary Prevention – On low/mod LLT – Consider LLT intensification Patients on low or moderate 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 6.51 Primary Prevention – On low/mod LLT – Consider LLT intensification (unless target already achieved)  As for 6.5 but excludes patients who have reached their target cholesterolAs Above.
Secondary Prevention

CDRC has recently created individual sections to make it easier for those working in Primary and Secondary Prevention.

Search NameSearch ReturnsNotes 
? Lipids 7.1 Secondary Prevention – Possible poor lipid lowering therapy concordancePatients with repeat lipid lowering 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. 
? Lipids 7.2 Secondary Prevention – Consider starting lipid loweringPatients who appear eligible for lipid lowering for primary and secondary prevention who don’t have recorded reason why not.Review patient: consider offering statin or other treatment recording ‘declined, not indicated’ etc. Record previous ADRs to lipid lowering treatment. 
? Lipids 7.3 Secondary Prevention – Consider setting lipid targetPatients 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 7.4 Secondary Prevention – Lipid target set but not achievedPatients with a lipid target which has not been achievedConsider intensification of lipid treatment or relaxation of target (e.g. for frail patients). 
? Lipids 7.5 Secondary Prevention – On low/mod LLT – Consider LLT intensification Patients on low or moderate 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 7.51 Secondary Prevention – On low/mod LLT – Consider LLT intensification (unless target already achieved)  As for 6.5 but excludes patients who have reached their target cholesterolAs Above.
? Lipids 7.6 Secondary Prevention – Consider intensification to very high intensity lipid loweringPatients 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 7.61 Secondary Prevention – Consider intensification to very high intensity lipid lowering (unless target already achieved)As for 4.4 but excluding patients who have reached their target cholesterol. As Above.
? Lipids 7.7 Secondary Prevention – Consider intensification – ASCVD and LDLC >2.6Patients 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. 
? Lipids 7.71 Secondary Prevention – Consider intensification – ASCVD and LDLC >2.6 (unless target nonHDL already achieved)As for 7.7 but excluding patients who have a lipid target and have achieved this target.As above.
? Lipids 7.72 Secondary Prevention – Consider intensification – ASCVD and LDLC >2.6 (target nonHDL set and already achieved)As for 7.7 but including patients who have a lipid target and have achieved this target.
Batch Contacting Patients to Consider Lipid Lowering Intensification 

The following process allows quick and effective contact with patients to consider intensification of lipid lowering therapy. 

  • Use these searches to identify people who might eligible for the process. Criteria are: 
    • Not manifest atherosclerosis 
    • Not previous tried high intensity statin 
    • Not clear reason to avoid high intensity statin 
    • Not declined intensification in the last year 
  • Use the communications annexe to send selected patients the following message and questionnaire. Add the code Offer of statin therapy to invited patients. Patients without a mobile number or email address will need to be contacted in a different way e.g. phone or letter. 

This is the text to cut and paste into the message – a preset can be created for future use. 

<forename> <surname> 

We’ve reviewed your record and you may benefit from better treatment of your cholesterol. Use the link below for more information. 

<staff_member_title> <staff_member_forename> <staff_member_surname> 

  • The patient will receive the following questionnaire.  Replies will appear as a task in SystmOne 

Patients who answer ‘yes’ can be contacted. To discuss intensification.  The two subsearches 4.61 and 4.62 divide patients into those who are likely to be relatively simple (only been on one statin previously) or more complicated (multiple previous statins or previous high intensity statins). 

Patients who answer ‘no’ should have the code Patient on maximal tolerated lipid lowering therapy added. 


Performance Searches

The following searches in the CDRC Performance > Lipids folder will provide a picture of your practice’s lipid management performance.

Overview
Search Name  Search Returns
1 Lipids – Overview 1.0 – Proportion of population on Lipid Rx Number of people with lipid lowering therapy on repeat prescription 
1 Lipids – Overview 1.1 On Lipid Rx with issue in last 3m Number of people with lipid lowering therapy on repeat prescription who have had a prescription in the last 3 months 
1 Lipids – Overview 1.2 On Lipid Rx with lipid target Number of people with lipid lowering therapy on repeat prescription who have a recorded lipid target 
1 Lipids – Overview 1.21 On Lipid Rx with lipid target and target achieved Number of people with lipid lowering therapy on repeat prescription who have achieved their lipid target 
1 Lipids – Overview 2.0 Has indication for lipid lowering All patients who appear to have a good indication for lipid lowering (primary and secondary prevention) 
1 Lipids – Overview 2.1 Has indication for lipid lowering on lipid lowering The number of patients in 2.0 who have lipid lowering medication on repeat 
1 Lipids – Overview 2.11 Has indication for lipid lowering on lipid lowering (high/very high intensity) The number of patients in 2.0 who have high/very high intensity lipid lowering medication on repeat 
1 Lipids – Overview 2.2 – Proportion where Lipid Rx indicated but not treated nor reason recorded Number of people who appear eligible for lipid lowering who do not have: Lipid lowering on repeat A clear reason for not using lipid lowering 
1 Lipids – Overview 3.0 – Proportion of patients to target for CVD risk assessment Number of patients with an estimated CVD risk >=10% who should be offered a formal CVD risk assessment 
  
Secondary Prevention
Search Name  Search Returns
2 Lipids – ASCVD 1.0 Has manifest atherosclerosis (ASCVD) Patients with AAA, CHD, PAD, ischaemic/unclassified stroke or TIA 
2 Lipids – ASCVD 1.1 Very high intensity lipid lowering Established ASCVD and on very high intensity lipid lowering 
2 Lipids – ASCVD 1.2 On high/very high intensity lipid lowering Established ASCVD and on high or very high intensity lipid lowering 
2 Lipids – ASCVD 1.3 On high/very high intensity Rx OR On low/mod intensity Rx with reason # Established ASCVD:  on high or very high intensity lipid lowering OR On low or moderate intensity lipid lowering with  maximal tolerated lipid lowering recorded in the last year OR Atorvastatin ADR recorded  
2 Lipids – ASCVD 1.4 On lipid lowering Established ASCVD on any lipid lowering 
2 Lipids – ASCVD 1.41 On lipid lowering – issued in the last 3 months Established ASCVD on any lipid lowering AND issued in the last 3 months 
2 Lipids – ASCVD 1.42 On lipid lowering – with cholesterol target Established ASCVD on lipid lowering therapy with a record of a lipid target (usually non-HDL cholesterol) 
2 Lipids – ASCVD 1.421 On lipid lowering – with cholesterol target – target achieved As 1.42 with target achieved 
2 Lipids – ASCVD 1.5 On lipid lowering OR Reason why not Established ASCVD on any lipid lowering or clear reason why not – should be aiming for 100% 
Familial Hypercholesterolemia
Search Name Search Returns
3 Lipids – FH 1.0 Definite or probable Definite or probable familial hypercholesterolaemia 
FH searches 1.1 – 1.5 as for the ASCVD searches above  
Primary Prevention of CVD by Lipid Modification
Search Name Search Returns
4 – Lipids – PP 1.0 Primary Prevention Indicated Primary prevention by lipid modification is likely to be recommended for these patients 
PP searches 1.1 – 1.6 as for the ASCVD searches above  
CVD Risk Assessment
Search Name Search Returns
5 Lipids – Assess CVD Risk 1 – estimated risk >=10% Patients whose estimated 10 year risk of CVD is >=10% who have not had a formal risk assessment.   
5 Lipids – Assess CVD Risk 2 – Already on lipid lowering without risk assessment Patients on lipid lowering without an obvious indication.   

Statin Safety

The following searches will identify important statin safety issues. Use the Lipid Lowering template to help. 

The following searches are found in the CDRC Quality > Lipids folder:

Statin safety issues.
Search NameSearch ReturnsNotes 
? Statin Safety 1.0 – Any statin – potential contraindicated interaction # Patients on repeat statin and another medication that appears to be contraindicated Review patient medication to ensure safety 
? Statin Safety 1.1 – Simvastatin – ! MHRA ! Any potential contraindicated interaction # (Subset of 1.0 above) Patients on simvastatin with a contraindicated medication in line with the MHRA warning Review record https://www.gov.uk/drug-safety-update/simvastatin-updated-advice-on-drug-interactions 
? Statin Safety 2.0 – Any statin – caution, potential interaction # Patients on repeat statin and another medication where caution is recommended Review patient medication to ensure safety  
? Statin Safety 3.0 – Any statin – consider dose in view of eGFR # Patients on repeat statin whose renal function indicates that dose alteration MAY be needed Review patient medication to ensure safety 

Footer

Follow us on social media

  • Facebook
  • LinkedIn
  • Twitter
  • Terms of Reference
  • Ethics & Governance
  • Privacy policy
  • Terms of use
  • Join CDRC Precision

Copyright © 2023 Clinical Digital Resource Collaborative