This analysis aims to examine how well NICE’s healthcare guidelines for assessing and managing cardiovascular disease risk are being followed.
First, we want to understand who is receiving assessments to check their risk of cardiovascular disease (CVD). We'll look at the kinds of patients who get these assessments, which tools are used, and the scores they receive.
Next, we'll focus on two groups of patients: those with high blood sugar or high blood pressure. We want to see if these higher-risk individuals are getting CVD assessments, as advised by NICE.
We're also interested in how often a type of medication, statins, is being used to prevent and treat CVD. For both people at risk of CVD (primary prevention) and people who already have CVD (secondary prevention), we'll see how many are taking the right type and dose of statin. Because some patients might not be getting the best treatment, we'll investigate if those with CVD were put on the right type of statin after their first heart-related event.
Lastly, we'll look at whether patients who start taking strong statins have their cholesterol and liver function checked within 3 months. This is important to ensure their safety and effectiveness.
For all these findings, we’ll also explore whether there are differences based on a person’s age, gender and how deprived the area they live in is.
The results will help make sure healthcare providers follow best practices, and they'll also guide future updates to the NICE guidelines for cardiovascular health.
This study measures the uptake of the NICE quality standard on cardiovascular risk assessment and lipid modification in primary care using CPRD Aurum. The objectives are to understand cardiovascular disease (CVD) risk assessment by characterising patients who received an assessment, which CVD risk tool was used and their scores. We will then look at the proportion of patients with type 2 diabetes or hypertension who received a CVD risk assessment to understand whether populations at increased risk of CVD are having their risk monitored.
We will then look at statin use for primary and secondary prevention of CVD. For primary prevention, we will measure the proportion of patients who have a QRISK score of 10% or more who are on atorvastatin 20mg (NICE-recommended). For secondary prevention, we will measure the proportion of patients with CVD who are on atorvastatin 80mg (NICE-recommended). As many CVD patients are on suboptimal statins, we will look at the proportion of CVD patients on statins who were on statins prior to their first CVD event and whether they received the recommended high-intensity statin following their CVD diagnosis.
Finally, we will look at reviews following initiation of high-intensity statins, critical for the efficacy and safety of statin treatment. We will measure the proportion of patients started on a high-intensity statin who had their cholesterol and liver function reviewed within 3 months.
This is a descriptive study with no statistical testing. The study populations and outcomes are evident from the wording of the proportions. To detect health inequalities, we will look at variation in uptake by age, gender and deprivation. The results will help NICE provide actionable intelligence to local partners and update our guidance, ensuring patients at high risk of CVD are managed and, alongside patients with CVD, are treated appropriately with lipid lowering therapies.
Key variables (descriptive study):
Cardiovascular disease risk assessment; age; deprivation; gender; type 2 diabetes; hypertension; CVD (stroke, transient ischaemic attack [TIA], coronary heart disease [CHD], peripheral arterial disease [PAD]; statins (atorvastatin 20mg; atorvastatin 80mg; low-, medium- and high-intensity); total cholesterol; high-density lipoprotein (HDL) cholesterol or non-HDL cholesterol; low-density lipoprotein (LDL) cholesterol; alanine aminotransferase; aspartate aminotransferase
Tsz Wing Vanessa Kam - Chief Investigator - National Institute for Health and Clinical Excellence - NICE
Tsz Wing Vanessa Kam - Corresponding Applicant - National Institute for Health and Clinical Excellence - NICE
Robert Willans - Collaborator - National Institute for Health and Clinical Excellence - NICE
Patient Level Index of Multiple Deprivation;CCG Pseudonyms