CHOL004 - LDL cholesterol less than or equal to 2.0
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.
The information contained within this article is from version 50 of the Business Rules for Quality and Outcomes Framework (QOF).
This indicator was updated in version 50 for the contract year 2025/26 with the wording of the indicator being changed, and some changes to the business rules around the timing and values of the cholesterol results. The wording was previously:
Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), or Stroke/Transient Ischaemic Attack (TIA) Register, who have a recording of LDL (Low-density Lipoprotein) cholesterol in the preceding 12 months that is 2.0 mmol/L or lower or where LDL cholesterol is not recorded a recording of non-HDL (High-density Lipoprotein) cholesterol in the preceding 12 months that is 2.6 mmol/L or lower.
There were also some changes to the achievement criteria to match the description so that the LDL reading takes priority.
Indicator definition
Indicator ID | Description |
Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), or Stroke/Transient Ischaemic Attack (TIA) Register, with the most recent cholesterol measurement in the preceding 12 months, showing as ≤ 2.0 mmol/L if it was an LDL (Low-density Lipoprotein) cholesterol reading or ≤ 2.6 mmol/L if it was a non-HDL (High-density Lipoprotein) cholesterol reading. For multiple readings on the latest date the LDL reading takes priority. |
What do the business rules mean?
What makes a patient eligible?
Patients are eligible for the CHOL004 denominator if:
- they have a diagnosis of at least one of:
- coronary heart disease (CHD)
- peripheral arterial disease (PAD)
- stroke or TIA
- and they do not have a history of haemorrhagic stroke
How to achieve the indicator
To meet the criteria for CHOL004, eligible patients must have:
- on the date of their latest cholesterol test in the contract year either:
- An LDL cholesterol test of 2.0 or lower
- Have no LDL test recorded but do have a non-HDL with a value of 2.6 or lower
NB where there are multiple readings on the latest date LDL cholesterol reading takes priority if available.
What will remove patients from eligibility?
- Patients who have maximal tolerated cholesterol lowering therapy in the contract year
- Patients for whom the cholesterol quality indicator care was unsuitable in the contract year
- Patients who have chosen not to have a cholesterol test in the contract year
- Patients who have chosen not to receive cholesterol quality indicator care in the contract year
- Patients who have been invited twice for review
- Patients whose most recent cholesterol reading in the contract year was above the levels followed by two invites at least 7 days apart (ie: a raised result which needs re-checking)
- Patients who were diagnosed with CHD, PAD or TIA in the last 9 months of the contract year
- Patients who were newly registered with the practice in the last 9 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?
Some laboratories may not be sending results with a code for LDL cholesterol attached.
Ensure early on in the contract year that LDL cholesterol results are being correctly being coded back to the clinical system.
Ensure early on in the contract year that LDL cholesterol results are being correctly being coded back to the clinical system.
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 indicator the cholesterol quality indicator care was unsuitable (CHOLPCAPU_COD)
SNOMED code | SNOMED code description |
135807000 | Lipid lowering therapy not indicated |
Patients who chose not to have a cholesterol test (CHOLDEC_COD)
SNOMED code | SNOMED code description |
141851000119107 | Lipid screening declined |
203151000000104 | Cholesterol test declined |
301111000000107 | Lipid disorder monitoring declined |
9471000175101 | Hyperlipidemia screening test declined |
Patients who chose not to receive cholesterol quality indicator care (CHOLPCADEC_COD)
SNOMED code | SNOMED code description |
135826008 | Lipid lowering therapy declined |
182981008 | Cholesterol reduction program 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 |