National Institute for Health and Care Excellence
NICE Indicators Consultation
Closing date: 5pm – 23rd February 2015
Organisation
HEART UK – The Cholesterol Charity
Title (e.g. Dr, Mr, Ms,
Prof)
Ms
Name
Jules Payne
Job title or role
Chief Executive
Address and post code
7 North Road
Maidenhead
Berkshire
Telephone number
01628 777046
Email address
jp@heartuk.org.uk
Please note: comments submitted on draft indicators are published on the NICE website.
The personal data submitted on this form will be used by the National Institute for Health and Care Excellence (NICE) for the purpose specified. The
information will not be passed to any other third party and will be held in accordance with the Data Protection Act 1998.
Please provide comments on the draft indicators on the form below, putting each new comment in a new row. Please note the
indicator or measure that you are commenting on in the ‘ID’ column.
In order to guide your comments, please refer to the general points for consideration on the NICE website as well as the specific
questions detailed within the consultation paper.
Please add rows as necessary.
Indicator / measure ID
Comments
HEART UK regretted the withdrawal in April 2014 of the following indicators from the
QOF, believing that it was an unhelpful move which may hinder progress in tackling
Cardiovascular Disease (CVD):
 CHD003 The percentage of patient with coronary heart disease whose last
measured total cholesterol (measured in the preceding 12 months) is 5 mmol/l
or less
 PAD003 The percentage of patients with peripheral arterial disease in whom the
last measured total cholesterol (measured in the preceding 12 months) is 5
mmol/l or less
 STIA004 The percentage of patients with stroke or TIA who have a record of
total cholesterol in the preceding 12 months
 STIA005 The percentage of patients with a stroke shown to be nonhameorrhagic or a history of TIA whose last measured total cholesterol
(measured in the preceding 12 months) is 5 mmol/l or less
 MH004 The percentage of patients aged 40 or over with schizophrenia, bipolar
affective disorder or other psychoses who have a record of total cholesterol in
the preceding 12 months.
The absence of cholesterol indicators on the current QOF for all conditions bar diabetes
and hypertension gives the impression that cholesterol is no longer recognised as a risk
factor of sufficient importance for CVD. This jeopardises the progress made over recent
Indicator / measure ID
Comments
years of trying to make cholesterol management a public health priority, and is at odds
with both the Joint British Societies guidance and NICE Lipid Modification Guideline.
Data collected through QOF indicators are useful markers of population health and
patient management. HEART UK is concerned about how data are now being captured
regarding cholesterol levels in patients with CHD and other conditions since April 2014.
QOF IND 1. The percentage of patients aged
between 25 and 84 years with schizophrenia,
bipolar affective disorder and other psychoses who
have had a CVD risk assessment performed in the
preceding 12 months.
We strongly endorse the proposal in this consultation to develop a national CVD
register. Amongst a range of benefits, this will help overcome issues of cholesterol
reporting since QOF indicators were retired.
 Do stakeholders think this indicator is more or less likely to improve cardiovascular
health in people with severe mental illness compared with the physical health check
indicators currently included on the NICE menu of indicators?
The current NICE menu of indicators includes an indicator on the percentage of
patients aged 40 and over with schizophrenia, bipolar affective disorder and other
psychoses who have a record of total cholesterol: hdl ratio in the preceding 15 months.
With elevated cholesterol being a major risk factor for CVD, HEART UK would like to
see a standalone indicator on cholesterol in this way. The charity regrets that a similar
such indicator was withdrawn from the QOF last year: MH004 (the percentage of
patients aged 40 or over with schizophrenia, bipolar, affective disorder or psychoses
who have a record of total cholesterol in the proceeding 12 months). How does
primary care currently deal with the specific needs of people with severe mental
illness in relation to smoking cessation?


How does primary care currently address weight management in people with
severe mental illness?
Do stakeholders consider there to be any specific areas of care which should be an
explicit requirement of care planning in primary care for all people with severe
mental illness?
Indicator / measure ID
QOF IND 2. The percentage of patients with
coronary heart disease, stroke or transient ischemic
attack, diabetes, hypertension, peripheral arterial
disease, heart failure, chronic obstructive pulmonary
disease, asthma, osteoarthritis and/ or rheumatoid
arthritis who have had a body mass index (BMI)
recorded in the preceding 12 months.
QOF IND 8. The percentage of patients aged
between 25 and 84 years, with a new diagnosis of
hypertension recorded between the preceding 1
April and 31 March who have had a face-to-face
cardiovascular risk assessment using the QRISK2
risk assessment tool within 3 months of the date of
the hypertension diagnosis.
QOF IND 10. The percentage of patients aged
between 25 and 84 years, with
a new diagnosis of hypertension recorded between
the preceding 1 April and 31 March who have a
recorded cardiovascular risk assessment score of
10% or greater who are currently treated with
statins.
Comments
 People with chronic conditions were identified as an appropriate population for BMI
assessment as a precursor to indicators focused on intervention. Do stakeholders
consider the scope of the conditions covered in the indicator suitable?
Yes, HEART UK considers the scope suitable.

NICE guidance recommends a systematic strategy to identify people likely to be at
highrisk before a full formal risk assessment is carried out. For the purposes of the
QOF, people with newly diagnosed diabetes and hypertension have been
pragmatically selected for a formal assessment of CVD risk. Can stakeholders
suggest a method to identify people ‘at high risk’ of CVD for the purposes of the
QOF?
HEART UK is of the view that the NHS Health Checks Programme is an important way
to engage the public in health prevention by identifying risk factors for CVD, providing
individuals with information to reduce their risk of CVD through lifestyle changes, and
reducing their risk of CVD through treatment where necessary. HEART UK would like
to see better data sharing between Local Authorities and Clinical Commissioning
Groups so that patients identified through the NHS Health Checks Programme are
managed as well as possible. We feel the national CVD register would fulfil this
requirement.
 NICE guidance recommends treatment with statin therapy for anyone who has a
CVD risk assessment score of 10% or greater where lifestyle modification is
ineffective or inappropriate. Do stakeholders think lifestyle modification and statin
therapy should be jointly incentivised? Yes, both are important.
 Do stakeholders think an indicator to specifically target lifestyle modification before
statin therapy would be beneficial? For example: The percentage of patients
diagnosed with hypertension (diagnosed on or after 1 April) who are given lifestyle
Indicator / measure ID
Comments
advice in the preceding 12 months for: smoking cessation, safe alcohol
consumption and healthy diet? Yes
QOF IND 11. The percentage of patients aged
 NICE guidance recommends treatment with statin therapy for anyone who has a
between 25 and 84 years, with a new diagnosis of
CVD risk assessment score of 10% or greater where lifestyle modification is
hypertension or diabetes recorded between the
ineffective or inappropriate. Do stakeholders think lifestyle modification and statin
preceding 1 April and 31 March who have a
therapy should be jointly incentivised? Yes
recorded cardiovascular risk assessment score of
 Do stakeholders think an indicator to specifically target lifestyle modification before
10% or greater who are currently treated with
statin therapy would be beneficial? For example: The percentage of patients
statins.
diagnosed with hypertension or diabetes (diagnosed on or after 1 April) who are
given lifestyle advice in the preceding 12 months for: smoking cessation, safe
alcohol consumption and healthy diet? Yes
QOF IND 12. The contractor establishes and
 NICE guidance (CG 181) recommends that a systematic strategy should be used to
maintains a register of patients with a 10-year risk of
identify people who are likely to be at high risk of CVD. The guideline suggests that
CVD of 10% or more.
people with an estimated 10 year risk of CVD of 10% or more should be prioritised
for further investigation and preventative treatment and interventions. Do
stakeholders think it would be feasible and desirable to have a register of all
patients identified as having a 10-year risk of CVD of 10% or more?
YES, HEART UK fully endorses this idea.
Closing date: Please forward this electronically by 5pm on 23rd February 2015 at the very latest to indicators@nice.org.uk
PLEASE NOTE: The Institute reserves the right to summarise and edit comments received during consultations, or not to publish them at all, where in the
reasonable opinion of the Institute, the comments are voluminous, publication would be unlawful or publication would be otherwise inappropriate.