QOF

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Total cholesterol Codes (Latest value <= 5 within last 12months)

44OE. Plasma total cholesterol level
44P.. Serum cholesterol
44PH. Total cholesterol measurement
44PJ. Serum total cholesterol level
44PK. Serum fasting total cholesterol
662a. Pre-treatment serum cholesterol level (v28)

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 cholesterol test declined (In last 12 months)

8I3w. Cholesterol test declined (v28)

Codes for blood test declined (In last 12 months)

41M.. Blood test declined (v28)

Codes for exception from serum cholesterol target; expiring (In last 12 months)

8BL1. Patient on maximal tolerated lipid lowering therapy
8I3C. Statin declined
8I27. Statins contraindicated
8I63. Statin not indicated
8I76. Statin not tolerated

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Diabetes exception reporting codes (Added in the last 12 months)

9h4.. Exception reporting: diabetes quality indicators
9h41. Excepted from diabetes quality indicators: Patient unsuitable
9h42. Excepted from diabetes quality indicators: Informed dissent

DM 004.1 Rationale

It is advised that statin therapy to reduce cholesterol is initiated and titrated as necessary to reduce total cholesterol to less than 5 mmol/l. There is ongoing debate concerning the intervention levels of serum cholesterol in diabetic patients who do not apparently have CVD.

The NICE clinical guideline on type 2 diabetes - newer agents recommends initiating lipid lowering therapy in all patients with type 2 diabetes aged over 40 and for patients aged 39 or under recommends initiating drug therapy in patients with type 2 diabetes who have a poor cardiovascular risk factor profile.

The SIGN clinical guideline on the management of diabetes recommends lipid lowering drug therapy for primary prevention in patients with type 2 diabetes aged 40 or over irrespective of baseline cholesterol. For patients with type 1 diabetes SIGN recommends lipid lowering drug therapy for patients aged 40 or over and for patients aged 39 or under with both type 1 and type 2 diabetes, recommends considering lipid lowering drug therapy.

Further information
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterollowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial (Lancet 2003; 361:2005-2016).

Mortality from CHD in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial Infarction Haffner et al (NEJM 1998; 339: 229-234)

SIGN clinical guideline 97 (2007). Risk estimation and the prevention of CVD.
http://www.sign.ac.uk/guidelines/fulltext/97/index.html

DM 004.2 Reporting and verification

See indicator wording for requirement criteria.

The contractor would be expected to explore fully with their CCG whether or not a suitable investigative or secondary service could be commissioned for the patient prior to deciding to except them on the basis that the services was unavailable..

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Prepared By Jean Keenan