CHOL003 - Patients on a statin or other lipid lowering drug

CHOL003 - Patients on a statin or other lipid lowering drug

The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF).                                                                     

Indicator definition

Indicator ID

Description

CHOL003

Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), Stroke/Transient Ischaemic Attack (TIA) or Chronic Kidney Disease (CKD) Register who are currently prescribed a statin, or where a statin is declined or clinically unsuitable, another lipid-lowering therapy.

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the CHOL003 denominator if:
  1. they have a diagnosis at least one of:
    1. coronary heart disease (CHD)
    2. peripheral arterial disease (PAD)
    3. stroke or TIA
    4. chronic kidney disease (CKD) 3-5 diagnosis, as well as being aged at least 18 years old and there is no subsequent CKD resolved or CKD stage 1 or 2 code
  2. and they do not have a history of haemorrhagic stroke
  3. and they do not have an unresolved diagnosis of diabetes

How to achieve the indicator

To meet the criteria for CHOL003, eligible patients must have:
  1. been issued a statin in the last 6 months of the contract year
  2. any of the criteria in Group 1 and be prescribed a drug from Group 2 in the last 6 months of the contract year
    Group 1:
    1. Patient has a statin intolerance code recorded ever (or)
    2. Patient has chosen not to receive a statin during the contract year (or)
    3. Patient has a persisting statin contraindication recorded ever (or)
    4. Patient has an expiring statin contraindication recorded during the contract year
           Group 2 (drugs):
    1. Bempedoic acid
    2. Ezetimibe
    3. Icosapent ethyl
    4. Inclisiran

    5. PCSK9 inhibitor

What will remove patients from eligibility?

  1. Patients on the palliative care register (without a more recent code of Palliative care not indicated)
  2. Patients who have maximal tolerated cholesterol lowering therapy in the contract year
  3. Patients who have allergies (ever), adverse reactions (ever), contraindications (in contract year), declined (in contract year) or not indicated (contract year) to each of the lipid lowering therapies: bempedoic acid, ezetimibe, icosapent ethyl, inclisiran and PCSK9 inhibitor
  4. Patients who have had a lipid lowering adverse reaction ever
  5. Patients who have a lipid lowering therapy contraindication code (ever) OR a lipid lowering therapy not indicated code in the contract year
  6. Patients who chose not to receive lipid lowering therapy in the contract year
  7. Patients who have been invited twice (at least 7 days apart) for review
  8. Patients who were newly registered with the practice in the last 3 months of the contract year

If a patient achieves the indicator at any point during the year, any exclusions that have also been added are ignored.

What are the common pitfalls/what do I need to watch out for?

If a patient does not want any lipid lowering medication, there are two approaches to excluding the patient:
  1. The short approach is to code Lipid lowering therapy declined and nothing else
  2. The long approach would be to first code Statin declined, then a declined code for each of the 5 alternative drug groups - a total of 6 codes
In approach 2, Statin declined is not strictly necessary, but would be good coding practice to use it.

SNOMED codes used in this indicator

The codes referenced in this article are taken from the NHS Technology Reference Update Distribution (TRUD).  Not all of these may be present or selectable in all clinical systems.

Codes indicating the patient is on maximal tolerated cholesterol lowering treatment (CHOLMAX_COD)

SNOMED code

SNOMED code description

407568002

Patient on maximal tolerated lipid lowering therapy

Codes indicating allergy to bempedoic acid (BEMPACIDALL_COD)

SNOMED code

SNOMED code description

1326571000000106

Allergy to bempedoic acid

Codes indicating adverse reaction to bempedoic acid (BEMPACIDADV_COD)

SNOMED code

SNOMED code description

1326581000000108

Adverse reaction to bempedoic acid

Bempedoic acid contraindicated codes (BEMPACIDCON_COD)

SNOMED code

SNOMED code description

1326611000000102

Bempedoic acid contraindicated

Bempedoic acid not indicated codes (BEMPACIDNIND_COD)

SNOMED code

SNOMED code description

1326601000000104

Bempedoic acid not indicated

Codes indicating the patient has chosen not to receive bempedoic acid (BEMPACIDDEC_COD)

SNOMED code

SNOMED code description

1326631000000105

Bempedoic acid refused

Codes indicating allergy to ezetimibe (EZETIMIBEALL_COD)

SNOMED code

SNOMED code description

1326121000000101

Allergy to ezetimibe

Codes indicating adverse reaction to ezetimibe (EZETIMIBEADV_COD)

SNOMED code

SNOMED code description

1326131000000104

Adverse reaction to ezetimibe

Ezetimibe contraindicated codes (EZETIMIBECON_COD)

SNOMED code

SNOMED code description

1326711000000108

Ezetimibe contraindicated

Ezetimibe not indicated codes (EZETIMIBENIND_COD)

SNOMED code

SNOMED code description

1326701000000106

Ezetimibe not indicated

Codes indicating the patient has chosen not to receive ezetimibe (EZETIMIBEDEC_COD)

SNOMED code

SNOMED code description

1326721000000102

Ezetimibe refused

Codes indicating allergy to icosapent ethyl (ICOSAETHYLALL_COD)

SNOMED code

SNOMED code description



Codes indicating adverse reaction to icosapent ethyl (ICOSAETHYLADV_COD)

SNOMED code

SNOMED code description

1556861000000103

Adverse reaction to icosapent ethyl

Icosapent ethyl contraindicated codes (ICOSAETHYLCON_COD)

SNOMED code

SNOMED code description

1556841000000104

Icosapent ethyl contraindicated

Icosapent ethyl not indicated codes (ICOSAETHYLNIND_COD)

SNOMED code

SNOMED code description

1556881000000107

Icosapent ethyl not indicated

Codes indicating the patient has chosen not to receive icosapent ethyl (ICOSAETHYDEC_COD)

SNOMED code

SNOMED code description



Codes indicating allergy to inclisiran (INCLISIRANALL_COD)

SNOMED code

SNOMED code description

1362871000000100

Allergy to inclisiran

Codes indicating adverse reaction to inclisiran (INCLISIRANADV_COD)

SNOMED code

SNOMED code description

1362881000000103

Adverse reaction to inclisiran

Inclisiran contraindicated codes (INCLISIRANCON_COD)

SNOMED code

SNOMED code description

1362051000000103

Inclisiran contraindicated

Inclisiran not indicated codes (INCLISIRANNIND_COD)

SNOMED code

SNOMED code description

1362041000000101

Inclisiran not indicated

Codes indicating the patient has chosen not to receive inclisiran (INCLISIRANDEC_COD)

SNOMED code

SNOMED code description

1362061000000100

Inclisiran refused

Codes indicating allergy to PCSK9 inhibitors (PCSK9IALL_COD)

SNOMED code

SNOMED code description

1326141000000108

Allergy to proprotein convertase subtilisin/kexin type 9 inhibitor 

1365331000000104
Allergy to evolocumab
1365431000000106
Allergy to alirocumab

Codes indicating adverse reaction to PCSK9 inhibitors (PCSK9IADV_COD)

SNOMED code

SNOMED code description

1326151000000106

Adverse reaction to proprotein convertase subtilisin/kexin type 9 inhibitor

1365341000000108
Adverse reaction to evolocumab
1365441000000102
Adverse reaction to alirocumab

PCSK9 inhibitors contraindicated codes (PCSK9ICON_COD)

SNOMED code

SNOMED code description

1326751000000107

Proprotein convertase subtilisin/kexin type 9 inhibitor contraindicat800ed

1365371000000102
Evolocumab contraindicated
1365411000000103
Alirocumab contraindicated

PCSK9 inhibitors not indicated codes (PCSK9ININD_COD)

SNOMED code

SNOMED code description

1326741000000109

Proprotein convertase subtilisin/kexin type 9 inhibitor not indicated

1365361000000109
Evolocumab not indicated
1365401000000100
Alirocumab not indicated

Codes indicating the patient has chosen not to receive PCSK9 inhibitors (PCSK9IDEC_COD)

SNOMED code

SNOMED code description

1326761000000105

Proprotein convertase subtilisin/kexin type 9 inhibitor refused

1365381000000100
Evolocumab declined
1365421000000109
Alirocumab declined

Adverse reaction to lipid lowering drug codes (LIPIDTHERADV_COD)

SNOMED code

SNOMED code description

293417004

Lipid-lowering drug adverse reaction

Lipid therapy contraindicated codes (LIPIDTHERCON_COD)

SNOMED code

SNOMED code description

135822005

Lipid lowering therapy contraindicated

Lipid therapy not indicated codes (LIPIDTHERNIND_COD)

SNOMED code

SNOMED code description

135807000

Lipid lowering therapy not indicated

Lipid therapy declined codes (LIPIDTHERDEC_COD)

SNOMED code

SNOMED code description

135826008

Lipid lowering therapy declined

Cholesterol invite codes (CHOLINVITE_COD)

SNOMED code

SNOMED code description

1109921000000100

Quality and Outcomes Framework quality indicator-related care invitation

310879007
Cholesterol reduction program - invited
711471000000106
Lipid disorder monitoring invitation
716001000000100
Lipid disorder monitoring first letter
716461000000106
Lipid disorder monitoring verbal invitation
716741000000100
Lipid disorder monitoring telephone invitation
716751000000102
Lipid disorder monitoring second letter

Codes for intolerance to statins (STATININTOL_COD)

SNOMED code

SNOMED code description



Codes indicating the patient has chosen not to receive a statin prescription (STATINDEC_COD)

SNOMED code

SNOMED code description

134396000

Statin declined

Statin contraindications (persisting) (XSTAT_COD)

SNOMED code

SNOMED code description

16524331000119104

History of rhabdomyolysis due to statin

293432006
3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor adverse reaction
293433001
Adverse reaction caused by simvastatin
293434007
Adverse reaction caused by fluvastatin
293435008
Adverse reaction caused by pravastatin
294970008
Allergy to 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor
294971007
Allergy to simvastatin
294972000
Allergy to fluvastatin
294973005
Allergy to pravastatin
787206005
Rhabdomyolysis due to statin

Statin contraindications (expiring) (TXSTAT_COD)

SNOMED code

SNOMED code description

134391005

Statin not indicated
315363002
Statins contraindicated
413174003
Statin not tolerated

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