Lipid management searches - user guidance

Data is searched for within a general practice system to identify patients in the practice who may benefit from changes to their lipid management therapy.

No data leaves the practice. The tool provides searches for use only by the practice.

Each system supplier provides guidance on how to access the searches in their system.

The tool is not mandatory

Lipid management searches are an additional tool, which will help to support clinicians and help to provide better patient outcomes. Use of the tool is not mandatory - it's an additional resource for healthcare professionals within primary care. It's also recognised that local searches may have been developed in line with local guidance and this new tool is an additional option for clinicians to utilise. 

Technical guidance

All technical queries relating to the tool should be raised with the relevant GP system supplier. 

Threshold for PCSK9i drugs (Alirocumab & Evolocumab) 

National guidance recommends a threshold of 4.0mmol/L for high-risk patients (any cardiovascular event) and 3.5mmol/L for very high risk (recurrent events or events in more than one cardiovascular bed). It is not possible to reliably distinguish patients with recurrent events so the lower threshold of 3.5mmol/L has been applied.

Entry criteria

One of the initial entry criteria is a raised level of non-HDL-C, or LDL-C or total cholesterol above the national guideline thresholds.

Clinical guidance

You may find that bempedoic acid appears to be recommended outside the NICE Technical Appraisal Guidance, for example it comes before ezetimibe and concomitant with statins.

The searches firstly assess patients for eligibility for high intensity statins and eligible patients would not appear in subsequent non-statin cohorts. The non-statin searches are not any rank order and do not recommend any one treatment before another. Clinicians assessing patients in the search lists would be expected to follow current clinical guidance.

Unexpected search results

Some general practice systems provide tools to identify why patients do or do not appear in a search. Guidance on these can be obtained from the supplier. The business rules that describe all of the searches in detail will also help explain this. 

Identified patients are not automatically eligible for treatment

These searches are designed to support practices in the management of patients with pre-existing cardiovascular disease, whose lipid control is suboptimal, in accordance with national guidelines.

They produce a series of patient cohorts which can be used for reviewing patient records and/or calling patients. Any decision to progress with treatment will be after a clinical assessment and must be based upon a clinician’s decision about their patient.

Patients who have declined lipid management are included

The national guidelines do not address patients who have declined lipid management therapy. A common-sense approach was taken on managing this group of patients and to suggest that they are still considered for newer therapies, particularly as most will have declined only statins in the past.

Patients who have adverse reactions or contraindications are included

'Adverse reaction', 'contraindicated' and 'not indicated' are recorded in general practice systems with very variable meanings or intentions and may be only temporary. Therefore, some patients with such codes are included in cohorts with the intention that the clinical assessment process will check the meaning and accuracy of these record entries.

Phased rollout approach

We've taken a phased rollout approach because different systems are used within General Practice and therefore lipid management searches are being deployed separately by each system supplier. This phased approach will allow us to identify any potential issues and resolve them throughout the deployment. 

Supplier access to lipid management searches

EMIS and Cegedim (Vision) practices will have access to lipid management searches first, followed by TPP practices.  

Availability of lipid management searches in all practices

All practices in England should have access to lipid management searches by the end of June 2022.