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.
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 Name | Search Returns | Notes |
| ? 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 Name | Search 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 patients | Patients 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 likely | Patients 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 testing | Patients 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 Name | Search Returns | Notes |
| ? 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.
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.
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 Name | Search Returns | Notes |
| ? 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.
The Medication Timeline and Lipid Results with Lipid Rx buttons can be used to examine concordance in more detail.
Optimising Lipid Modification
The following searches will identify patients who may need lipid modification optimisation.
| Search Name | Search Returns | Notes |
| ? 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:
May Need Specialist Lipid Management (PCSK9i, Inclisiran)
The following searches will identify patients who may need more specialist input:
| Search Name | Search Returns | Notes |
| ? 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:
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 Name | Search Returns | Notes |
| ? Lipids 6.1 Primary Prevention – Possible poor lipid lowering therapy concordance | Patients 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 lowering | Patients 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 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 6.4 Primary Prevention – Lipid target set 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 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 cholesterol | As Above. |
Secondary Prevention
CDRC has recently created individual sections to make it easier for those working in Primary and Secondary Prevention.
| Search Name | Search Returns | Notes |
| ? Lipids 7.1 Secondary Prevention – Possible poor lipid lowering therapy concordance | Patients 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 lowering | Patients 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 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 7.4 Secondary Prevention – Lipid target set 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 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 cholesterol | As Above. |
| ? Lipids 7.6 Secondary Prevention – 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 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 >2.6 | 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. |
| ? 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 Name | Search Returns | Notes |
| ? 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 |