QOF

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BP codes

BP Exception code (Added in the last 12 months)

8I3Y. Blood pressure procedure refused

Maximum BP therapy (Added in last 12 months)

8BL0. Patient on maximal tolerated antihypertensive therapy

BP Codes (Added in last 12 months)

The latest Systolic <=150 and Diastolic <=90

246% O/E - blood pressure reading,

Excluding:

2460 O/E - BP unrecordable (v7)
2468. O/E - BP reading:postural drop
246H. O/E - Arterial pressure index normal
246I. O/E - Arterial pressure index abnormal
246K. Target systolic blood pressure
246L. Target diastolic blood pressure
246M. White coat hypertension
246h. Arterial pulse pressure
246i. Diastolic blood pressure centile
246j. Systolic blood pressure centile
246k. Unequal blood pressure in arms

In detail:

246. O/E - blood pressure reading
2461. O/E - BP reading very low
2462. O/E - BP reading low
2463. O/E - BP borderline low
2464. O/E - BP reading normal
2465. O/E - BP borderline raised
2466. O/E - BP reading raised
2467. O/E - BP reading very high
2469. O/E - Systolic BP reading
246A. O/E - Diastolic BP reading
246B. O/E - BP stable
246C. Lying blood pressure reading
246D. Standing blood pressure reading
246E. Sitting blood pressure reading
246F. O/E - blood pressure decreased
246G. O/E - BP labile
246J. O/E - BP reading: no postural drop
246N. Standing systolic blood pressure
246P. Standing diastolic blood pressure
246Q. Sitting systolic blood pressure
246R. Sitting diastolic blood pressure
246S. Lying systolic blood pressure
246T. Lying diastolic blood pressure
246V. Average 24 hour diastolic blood pressure
246W. Average 24 hour systolic blood pressure
246X. Average day interval diastolic blood pressure
246Y. Average day interval systolic blood pressure
246Z. O/E-blood pressure reading NOS
246a. Average night interval diastolic blood pressure
246b. Average night interval systolic blood pressure
246c. Average home diastolic blood pressure
246d. Average home systolic blood pressure
246e. Ambulatory systolic blood pressure
246f. Ambulatory diastolic blood pressure
246g. Self measured blood pressure reading
246l. Average systolic blood pressure
246m. Average diastolic blood pressure
246n. Baseline blood pressure (v30)

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Peripheral Arterial Disease (PAD)

Peripheral Arterial Disease diagnosis codes

G73.. Other peripheral vascular disease
G73y. Other specified peripheral vascular disease (v26)
G73z. Peripheral vascular disease NOS
G73z0 Intermittent claudication
G73zz Peripheral vascular disease NOS
Gyu74 [X]Other specified peripheral vascular diseases
G734. Peripheral arterial disease

Peripheral Arterial Disease exception reporting codes

This exception is only applicable for the first ‘ever’ diagnosis of PAD for the patient. For a subsequent diagnosis, this exception rule is not considered.

9hS.. Exception reporting: peripheral arterial disease quality indicators
9hS0. Excepted from peripheral arterial disease quality indicators: patient unsuitable
9hS1. Excepted from peripheral arterial disease quality indicators: informed dissent
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Peripheral Arterial Disease 002.1 Rationale

Most cases of PAD are managed in primary care. The focus of treatment is on the cardiovascular complications of atherosclerosis (that is, managing cardiovascular risk factors such as high blood pressure). Two small UK studies assessing clinical risk management based on the medical records of patients with PAD suggest that these patients have poor hypertension control, use low levels of statin and antiplatelet therapy, and receive low levels of smoking cessation advice. This indicator addresses the issue of blood pressure control.
Bradley L, Kirker SG. Secondary prevention of arteriosclerosis in lower limb vascular amputees: a missed opportunity (2006) European Journal of Vascular and Endovascular Surgery 32: 491-493
Khan S, Flather M, Mister R et al. (2007) Characteristics and treatments of patients with peripheral arterial disease referred to UK vascular clinics: results of a prospective registry. European Journal of Vascular and Endovascular Surgery 33: 442-450

The SIGN guideline on the diagnosis and management of PAD, 89, recommends that hypertensive patients with PAD should receive treatment to reduce their blood pressure. The guideline developers noted that treatment of PAD has often been considered difficult because ofconcerns that antihypertensive drugs, especially beta blockers, may have adverse effects on PAD (for example, possible drug-induced peripheral vasoconstriction leading to further ischaemia in the leg).The developers did not find any strong evidence to suggest that beta-blockers should not be used in the presence of PAD, although no study was sufficiently large to demonstrate an absence of adverse events with certainty.

Recommendation 2.6 in the SIGN guideline does not specify a target blood pressure in patients with PAD. However, the guideline developers considered that 140/90 mmHg is a desirable upper limit and that around one third to one half of patients with PAD would be considered hypertensive above this level.

The NICE clinical guideline on Hypertension sets blood pressure thresholds for the initiation of drug treatment of hypertension and these are outlined in the rationale for the hypertension domain. All patients aged under 80 years with CVD and stage 1 hypertension (clinic blood pressure is 140/90 mmHg or higher and subsequent ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 or higher) are recommended drug therapy for hypertension.

The NICE clinical guideline on Hypertension recommends a target clinic blood pressure below 140/90 mmHg in patients aged 79 or under with treated hypertension and a clinic blood pressure below 150/90 mmHg in patients aged 80 years and over, with a treated hypertension.

For the purpose of QOF, a measurement of 150/90 has been adopted for this indicator.

Health economic modelling of PAD and the costs and consequences of treating high blood pressure over a patient’s lifetime suggests that this treatment is a cost effective use of NHS resources.

NICE CG127. Hypertension: clinical management of primary hypertension in adults. 2011.
http://publications.nice.org.uk/hypertension-cg127

Peripheral Arterial Disease 002.2 Reporting and verification

See indicator wording for requirement criteria.

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Prepared By Jean Keenan