{"id":2416,"date":"2020-09-28T22:00:39","date_gmt":"2020-09-28T21:00:39","guid":{"rendered":"https:\/\/cdrc.nhs.uk\/?page_id=2416"},"modified":"2024-04-26T11:15:59","modified_gmt":"2024-04-26T10:15:59","slug":"lipids-familial-hypercholesterolaemia-fh-and-pcsk9i-guide-for-emis","status":"publish","type":"page","link":"https:\/\/cdrc.nhs.uk\/resources\/emis-resource-centre\/emis-specialties\/emis-cardiovascular-overview\/lipids-familial-hypercholesterolaemia-fh-and-pcsk9i-guide-for-emis\/","title":{"rendered":"Lipids, Familial Hypercholesterolaemia (FH), PCSK9i & Inclisiran Guide for EMIS"},"content":{"rendered":"\n

A suite of Population Reporting searches for EMIS, created by the CDRC can be used identify patients in your practice who might benefit from lipid lowering or optimisation of treatment. <\/p>\n\n\n\n

To enable actioning of these Population Reporting searches with guided instruction for patient care, please use the CDRC Lipid Management Template which can be accessed using the CDRC Precision Launcher. This holistic tool allows for accurate assessment, coding and management of patients to help meet best practice, QoF and PCN DES IIF indicators.<\/p>\n\n\n\n

Accessing the Population Reporting Searches<\/summary>
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To access the CDRC Lipids Population Reporting Searches on EMIS, you will need to download and import the following .zip file:<\/p>\n\n\n\n

CDRC Quality Lipids (22nd April 2024)<\/a>Download<\/a><\/div>\n\n\n\n

If you have not performed this process before, please refer to the Download\/ Import guide below, which provides you with step-by-step instructions on how to Download and Import .zip files into EMIS:<\/p>\n\n\n\n

EMIS Zip File Download and Import Guide<\/a>Download<\/a><\/div>\n\n\n\n

You can check whether you have the most up-to-date version by reviewing the date on the .zip file. Any updates to the Population Reporting searches will be communicated to CDRC Precision users via the mailing list for the CDRC. To ensure you stay up to date with the latest information, please sign up to the mailing list at http:\/\/eepurl.com\/9131L<\/a> <\/p>\n<\/div><\/details><\/div>\n\n\n\n

Guidance on the Population Reporting Searches<\/summary>
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To view CDRC’s focused Population Reporting Lipid searches navigate to the CDRC Quality Lipids (22nd April 2024) folder and open the CDRC Quality Lipids Focused Reports folder. <\/strong><\/p>\n\n\n\n

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The Focused Population Reporting Lipids searches in this folder are highlighted below along with information that explains the patients these searches return.<\/p>\n\n\n\n

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Lipid Screening – Screening for people at risk of CVD<\/h3>\n\n\n\n
Report Name<\/strong><\/td>Report Returns<\/strong><\/td><\/tr>
? 1.0 Screening \u2013 Target CVD Risk Assessment (estimated risk is >10%)<\/td>Patients who have an estimated QRisk2 calculated (un-coded) who may be eligible for a targeted CVD Risk assessment.<\/td><\/tr>
? 1.1 Screening \u2013 Target CVD Risk Assessment \u2013 eligible for NHS Health check<\/td>Patient’s included in report 1.0 that you could recall for an NHS Health Check.<\/td><\/tr>
? 1.2 Screening \u2013 Target CVD Risk Assessment \u2013 has LTC<\/td>Patient’s included in report 1.0 that you could recall for an LTC review (excluding respiratory reviews).<\/td><\/tr>
? 1.3 Screening \u2013 Target CVD Risk Assessment \u2013 not NHS Health check or LTC<\/td>Patient’s included in report 1.0 excluding those that could be invited for an NHS Health Check or an LTC review. These patients could potentially be missed from any routine recall but existing coding in their record suggests they have a QRisk2 >10%.<\/td><\/tr>
? 1.4 Screening – Target CVD Risk Assessment – BAME<\/td>BAME patients who have an estimated QRisk2 calculated (un-coded) who may be eligible for a targeted CVD Risk assessment.<\/td><\/tr>
? 1.5 Screening – Target CVD Risk Assessment – Core20Plus5<\/td>Core20Plus5 patients who have an estimated QRisk2 calculated (un-coded) who may be eligible for a targeted CVD Risk assessment.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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Lipid Screening – Screening for Familial Hypercholesterolaemia<\/h3>\n\n\n
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Report Name<\/strong><\/td>Report Returns<\/strong><\/td><\/tr>
? 2.0 Case Finding \u2013 Consider screening for familial hypercholesterolaemia<\/td>Patients who may have familial hypercholesterolaemia based on the DLCN criteria, Simon Broome and NICE Plus criteria.<\/td><\/tr>
? 2.01 Case Finding \u2013 Consider screening for FH \u2013 highest risk patients<\/td>Patients included in the report 2.0 with the highest risk scores that are most likely to have FH.<\/td><\/tr>
? 2.1 Case Finding \u2013 Code for FH but no genetic code \u2013 consider gene test<\/td>Patients that have a possible\/probable\/FH code who do not have a  genetic FH code diagnosis.  These patients should be reviewed and genetic code added, or referral made, or removal of FH code if incorrect (e.g. Patient has secondary hyperlipidaemia).<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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Lipid Management – Consider Starting \/ Restarting Lipid Lowering<\/h3>\n\n\n
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Report Name<\/strong><\/td>Report Returns<\/strong><\/td><\/tr>
? 3.0 Management – Consider Lipid Lowering<\/td>Patients who appear eligible for lipid lowering for primary or secondary prevention who don\u2019t have a recorded reason why not<\/td><\/tr>
? 3.1 Management \u2013 Consider Lipid Lowering – Secondary Prevention<\/td>Patients with manifest atherosclerosis who are not taking lipid lowering medication with no clear indication why.<\/td><\/tr>
? 3.2 Management \u2013 Consider Lipid Lowering – Primary Prevention<\/td>Patients with coded reasons to be on lipid lowering medication who are not.\u00a0

There are further subdivisions of this report that identify specific patient cohorts:<\/td><\/tr>
? 3.3 Management \u2013 Possible poor lipid lowering therapy concordance<\/td>Patient’s who are prescribed lipid lowering medication, but they have not had an issue in the last 3 months.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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Lipid Management – Lipid Lowering Optimisation<\/h3>\n\n\n\n
Report Name<\/strong><\/td>Report Returns<\/strong><\/td><\/tr>
? 4.1 Management – On lipid lowering – without a target <\/td>Patients with repeat lipid lowering therapy who do not have a lipid target. <\/td><\/tr>
? 4.2 Management – On lipid lowering – has lipid target but not achieved <\/td>Patients with a lipid target which has not been achieved.<\/td><\/tr>
? 4.3 Management – On low\/mod lipid lowering – consider intensification<\/td>Patients on moderate or low potency lipid lowering without a documented reason.<\/td><\/tr>
? 4.31 Management – Patient’s in ? 4.3 excluding achieved targets<\/td>As for 4.3 but excludes patients who have reached their target cholesterol.<\/td><\/tr>
? 4.4 Management – Consider intensification to v.high intensity lipid lowering<\/td>Patients eligible for secondary prevention who are not on very high intensity lipid lowering.<\/td><\/tr>
? 4.41 Management – Patient’s in ? 4.3 excluding achieved targets<\/td>As for 4.4 but excluding patients who have reached their target cholesterol.<\/td><\/tr>
? 4.5 Management – Consider intensification, ASCVD & LDL >=2.6\/ nonHDL >=2.5 <\/td>Patients with ASCVD with LDL >=2.6 or Non HDL >=2.5<\/td><\/tr>
? 4.7 Management – Lipids Check Overdue<\/td>Patients who have not had a lipid check in the last 15 months.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

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Lipid Management \u2013 May Need Specialist Lipid Management<\/h3>\n\n\n\n
Report Name<\/strong><\/td>Report Description<\/strong><\/td><\/tr>
? 5.1 Management \u2013 Consider lipid lowering \u2013 may more detailed input<\/td>Patients who appear to need lipid lowering but have had ADR to at least one statin AND ezetimibe \u2013 may need specialist input <\/td><\/tr>
? 5.2 Management \u2013 Referral criteria for PCSK9i but poor concordance with current treatment<\/td>Fulfil referral criteria for PCSK9i therapy but may not be taking current lipid lowering therapy<\/td><\/tr>
? 5.3 Management \u2013 Referral Criteria for PCSK9i \u2013 Consider primary care intensification<\/td>Fulfil referral criteria for PCSK9i therapy but there may be scope for intensification of lipid lowering therapy in primary care <\/td><\/tr>
? 5.4 Management \u2013 Referral Criteria for PCSK9i \u2013 Consider referral<\/td>Likely to be eligible for PCSK9i referral <\/td><\/tr>
? 5.5 Management \u2013 Referral criteria for Inclisiran but poor concordance with current treatment<\/td>Fulfil referral criteria for Inclisiran therapy but may not be taking current lipid lowering therapy<\/td><\/tr>
? 5.6 Management \u2013 Referral Criteria for Inclisiran \u2013 Consider primary care intensification<\/td>Fulfil referral criteria for Inclisiran therapy but there may be scope for intensification of lipid lowering therapy in primary care <\/td><\/tr>
? 5.7 Management \u2013 Referral Criteria for Inclisiran \u2013 Consider referral<\/td>Likely to be eligible for Inclisiran referral <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Lipid Management – Primary Prevention <\/h3>\n\n\n\n
Report Name<\/strong><\/td>Report Returns<\/strong><\/td><\/tr>
? 6.1 PP \u2013 Possible poor lipid lowering therapy concordance<\/td>Patients with repeat lipid lowering who have not been issued a prescription in the last 3 months.<\/td><\/tr>
? 6.2 PP \u2013 Consider starting lipid lowering<\/td>Patients who appear eligible for lipid lowering for primary and secondary prevention who don\u2019t have recorded reason why not.<\/td><\/tr>
? 6.3 PP \u2013 Consider setting lipid target<\/td>Patients with repeat lipid lowering therapy who do not have a lipid target.<\/td><\/tr>
? 6.4 PP \u2013 Lipid target set but not achieved<\/td>Patients with a lipid target which has not been achieved.<\/td><\/tr>
? 6.5 PP \u2013 On low\/mod LLT \u2013 Consider LLT intensification <\/td>Patients on low or moderate potency lipid lowering without a documented reason.<\/td><\/tr>
? 6.51 PP \u2013 On low\/mod LLT \u2013 Consider LLT intensification (unless target already achieved)  <\/td>As for 6.5 but excludes patients who have reached their target cholesterol.<\/td><\/tr>
? 6.P PP – Lipid check overdue<\/td>Patients who have not had a lipid check in the last 15 months<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Lipid Management – Secondary Prevention<\/h2>\n\n\n\n
Report Name<\/strong><\/td>Report Returns<\/strong><\/td><\/tr>
? 7.0 SP – Has manifest atherosclerosis (ASCVD)<\/td>All ASCVD coded patients.<\/td><\/tr>
? 7.1 SP \u2013 Possible poor lipid lowering therapy concordance<\/td>Patients with repeat lipid lowering who have not been issued a prescription in the last 3 months.<\/td><\/tr>
? 7.2 SP \u2013 Consider starting lipid lowering<\/td>Patients who appear eligible for lipid lowering for primary and secondary prevention who don\u2019t have recorded reason why not.<\/td><\/tr>
? 7.3 SP \u2013 Consider setting lipid target<\/td>Patients with repeat lipid lowering therapy who do not have a lipid target. <\/td><\/tr>
? 7.4 SP \u2013 Lipid target set but not achieved<\/td>Patients with a lipid target which has not been achieved<\/td><\/tr>
? 7.5 SP \u2013 On low\/mod LLT \u2013 Consider LLT intensification <\/td>Patients on low or moderate potency lipid lowering without a documented reason.<\/td><\/tr>
? 7.5.1 SP – On low\/mod LLT- Consider LLT intensification (unlss target achvd)<\/td>As for 7.5 but excludes patients who have reached their target cholesterol<\/td><\/tr>
? 7.6 SP – Consider intensification to v.high intensity lipid lowering<\/td>Patients eligible for secondary prevention who are not on very high intensity lipid lowering.<\/td><\/tr>
? 7.7 SP – Consider intensification (NICE) – ASCVD w\/o nHDLC<=2.6 OR LDLC<=2.0<\/td>ASCVD patients and their latest Non-HDLC is not <=2.6 or their latest LDLC is not <=2.0<\/td><\/tr>
? 7.71 SP – ? 7.7 & personal target not set OR set but not achieved<\/td>As for 7.7 but excluding <\/strong>patients who do not have a lipid target OR have a target and have not achieved this target.<\/td><\/tr>
? 7.71 SP – ? 7.7 & personal target set and achieved<\/td>As for 7.7 but including <\/strong>patients who have a lipid target and have achieved this target.<\/td><\/tr>
? 7.9 SP – Lipid check overdue<\/td>Patients who have not had a lipid check in the last 15 months<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div><\/details><\/div>\n\n\n\n
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CDRC Lipid Management Template<\/summary>
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The Lipid Management Template is an intelligent template that helps guide clinicians through their patient’s lipid management, presenting relevant information depending on whether it is for primary prevention, secondary prevention and whether or not they are at target. <\/p>\n\n\n\n

To access the CDRC Lipid Management Template, you will need to have the CDRC Precision Resource Launcher enabled at your practice. Information on how to do this can be found by clicking on the link below:<\/p>\n\n\n\n