Lipids disorders: FH assessment (29 years and under)
Indicator
The percentage of people aged 29 years and under, with a total cholesterol concentration greater than 7.5 mmol/l that are assessed against the Simon Broome or Dutch Lipid Clinic Network (DLCN) criteria.
Indicator type
General practice indicator for use outside the QOF. Development and testing highlighted that there would be less than 20 new eligible patients per GP practice per year.
This document does not represent formal NICE guidance. For a full list of NICE indicators, see our menu of indicators.
To find out how to use indicators and how we develop them, see our NICE indicator process guide.
Rationale
In some people high total cholesterol levels are caused by an inherited gene defect: familial hypercholesterolemia (FH). A raised cholesterol concentration is present from birth and may lead to early development of atherosclerotic disease.
Left untreated, FH can lead to premature coronary heart disease. However, with appropriate lipid-lowering treatment, care is highly effective and life expectancy can return to normal (Qureshi et al. 2016)
The prevalence of heterozygous FH in the UK population is estimated to be 1 in 250. Currently it is estimated that up to 80% of people with FH are undiagnosed and therefore untreated.
Diagnosis is based on the Simon Broome or DLCN criteria which includes information on family history, total and LDL cholesterol concentrations, clinical signs such as tendon xanthomata and DNA testing.
This indicator is intended to increase identification of those aged 29 years and under with undiagnosed FH. Considering a diagnosis of FH in primary care will result in greater identification and support cascade testing of relatives. It will lead to more treatment of high cholesterol and the prevention of CHD amongst people with FH.
Source guidance
Familial hypercholesterolaemia: identification and management. NICE guideline CG71 (2008, updated 2019), section 1.1
Specification
Numerator: The number of people in the denominator who are assessed against the Simon Broome or DLCN criteria.
Denominator: The number of people aged 29 years and under, with a total cholesterol concentration greater than 7.5 mmol/l.
Calculation: Numerator divided by the denominator, multiplied by 100.
Exclusions: People previously assessed against the Simon Broome or DLCN criteria or referred for specialist assessment.
Minimum population: The indicator would not be appropriate to assess performance at individual general practice level. The indicator may be appropriate to assess performance of collaborations or networks of GP practices.
ISBN: 978-1-4731-5789-7