Total cholesterol Codes (The latest value <= 5 within last 15 months)
- 44OE. Plasma total cholesterol level
- 44P.. Serum cholesterol
- 44P1. Serum cholesterol normal
- 44P2. Serum cholesterol borderline
- 44P3. Serum cholesterol raised
- 44P4. Serum cholesterol very high
- 44PH. Total cholesterol measurement
- 44PJ. Serum total cholesterol level
Codes for exception from serum cholesterol target; persisting (ever recorded)
- U60CA [X]Statin causing adverse effect in therapeutic use
- TJC24 Adverse reaction to simvastatin
- TJC25 Adverse reaction to pravastatin
Codes for exception from serum cholesterol target; expiring (Added in last
15 months)
- 8BL1. Patient on maximal tolerated lipid lowering therapy
- 8I3C. Statin declined
- 8I27. Statins contraindicated
- 8I63. Statin not indicated
- 8I76. Statin not tolerated
-
CHD Diagnosis Codes
- G3... Ischaemic heart disease - G330z Angina decubitus NOS
- G33z. Angina pectoris NOS - G3401 Double coronary vessel disease
- G342. Atherosclerotic cardiovascular disease - G366. Thrombosis of atrium,
auricular appendage, and ventricle as current complications following acute
myocardial infarction
- G38.. Postoperative myocardial infarction - G3z.. Ischaemic heart disease
NOS
- Gyu3. [X]Ischaemic heart diseases
- Gyu30 [X]Other forms of angina pectoris
- Gyu31 [X]Other current complications following acute myocardial infarction
- Gyu32 [X]Other forms of acute ischaemic heart disease
- Gyu33 [X]Other forms of chronic ischaemic heart disease
- Gyu34 [X]Acute transmural myocardial infarction of unspecified site
- Gyu35 [X]Subsequent myocardial infarction of other sites
- Gyu36 [X]Subsequent myocardial infarction of unspecified site
CHD exception reporting codes (In last 15 months)
- 9h0.. Exception reporting: CHD quality indicators
- 9h01. Excepted from CHD quality indicators: Patient unsuitable
- 9h02. Excepted from CHD quality indicators: Informed dissent
CHD 8.1 Rationale
A number of randomised controlled trials of statin therapy in
the secondary prevention of CHD have shown a reduction in relative risk of cardiac
events irrespective of the starting level of cholesterol (see
reference in 7.1). Recent trials have found greater relative benefit with
more potent cholesterol lowering regimes. It is likely that national guidelines
relating to statin therapy in patients with CHD will change to recommend statin
therapy for all patients with CHD irrespective of their starting level of total
cholesterol.
However, currently the Joint British Recommendations on Prevention
of Coronary Heart Disease in Clinical Practice (1998) and SIGN Guidelines 93,
96 and 97 recommend that patients who have a cholesterol of greater than 5 mmol/l
should be offered lipid lowering therapy. This should be treated as an audit
target below which to aim for all eligible CHD patients.
The guidance here is given in terms of total cholesterol, as
this is used in national guidance and in trials.
CHD 8.2 Reporting and verification
Practices should report the percentage of patients on the CHD
register who have a record of total cholesterol in the previous 15 months which
is 5 mmol/l or less.
In verifying that this information has been correctly recorded,
a number of approaches could be taken by a PCO:
- inspection of the output from a computer search that has been used to provide
information on this indicator
- inspection of a sample of records of patients with CHD to look at the proportion
with recorded serum cholesterol 5 mmol/l or less
- inspection of a sample of records of patients for whom a record of serum
cholesterol at 5 mmol/l is claimed, to see if there is evidence of this in
the medical records.
Prepared By Jean Keenan