Cardiovascular risk assessment and lipid modification

  • Quality standard
  • QS100
  • Published: 
  • Last updated: 
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Quality statement 1: Identifying adults who are likely to be at high risk

Quality statement

General practices use a systematic strategy to identify adults likely to be at high risk of cardiovascular disease. [new 2025]

Rationale

Cardiovascular disease (CVD) is the most common cause of death in the UK, and is a major cause of illness, disability and poor quality of life. To improve primary prevention, adults at increased risk of CVD need to be identified using a systematic strategy so that their risk factors can be managed in the most effective way. This should not prevent people being identified opportunistically but may help to ensure that those with the highest risk of CVD are reviewed in an effective and efficient way. Factors routinely recorded in electronic patient records can be used to estimate CVD risk using a CVD risk assessment tool, and those at high risk should be invited for full formal risk assessment.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence that general practices use a systematic strategy to identify adults who are likely to be at high risk of CVD.

Data source: Data can be collected from local implementation plans.

b) Evidence that general practices use the QRISK3 tool to estimate CVD risk, or QRISK2 if QRISK3 is not currently embedded in electronic clinical systems.

Data source: Data can be collected from local implementation plans.

Process

The systematic strategies used by different localities will focus on different groups of people depending on the individual GP practice and so example process measures have not been provided. Some localities may want to focus on known local health inequalities or NHS England's Core20PLUS5, for example, by disaggregating data by socioeconomic status, ethnic family background, sex or presence of a learning disability. Measures could also focus on adults with modifiable risk factors or coexisting conditions that increase CVD risk.

What the quality statement means for different audiences

Service providers (primary care providers) ensure that they use a systematic strategy to identify adults who are likely to be at high risk of CVD. The strategy could use general practice records or systematic searches in pre-identified areas or with specific populations.

Healthcare professionals (such as GPs, nurses and pharmacists) identify adults who are likely to be at high risk of CVD using risk factors already in patient records. They review estimates of CVD risk on an ongoing basis for adults aged over 40.

Commissioners ensure that they commission services that use systematic strategies to identify adults who are likely to be at high risk of CVD using CVD risk factors already recorded.

Adults who are likely to have a high risk of CVD are identified by their healthcare provider so that their risk factors can be managed in the most effective way.

Definitions of terms used in this quality statement

Factors routinely recorded in electronic patient records

Factors routinely recorded in general practice patient records that could be used as part of a systematic strategy to identify adults with an increased CVD risk, include, but are not limited to:

  • age

  • sex

  • family history of CVD

  • ethnicity

  • smoking status

  • presence of other conditions known to associate with higher CVD risk such as diabetes, chronic kidney disease, atrial fibrillation, rheumatoid arthritis, systemic lupus erythematosus, severe mental illness, migraine and erectile dysfunction

  • use of antipsychotic, immunosuppressant or steroid medication

  • blood pressure

  • lipid levels

  • BMI.

[Adapted from NICE's clinical knowledge summary on risk factors for CVD and expert opinion]

Adults likely to be at high risk of CVD

Adults with an estimated 10-year risk of CVD of 10% or more. [NICE's guideline on cardiovascular disease: risk assessment and reduction, including lipid modification, section 1.1 and recommendation 1.1.4]

Equality and diversity considerations

CVD risk can be estimated based on factors routinely recorded in general practice. However, the accuracy of estimated risk scores will be adversely affected if relevant data is not accurately recorded in GP records, which is especially likely for vulnerable and underserved populations. To mitigate perpetuating or exacerbating existing health inequalities, 'batch coding' without clinical judgement should be avoided. Additionally, resultant data should be disaggregated by deprivation, ethnicity, age and gender to help reduce the risk of widening health inequalities.

Clinical judgement should inform interpretation of results from CVD risk tools because tools may underestimate the risk for certain groups of people, including, but not limited to:

  • people treated for HIV

  • people already taking medicines to treat CVD risk factors

  • people who have recently stopped smoking

  • people taking medicines that can cause dyslipidaemia, such as immunosuppressant drugs

  • people with severe mental illness

  • people with autoimmune disorders, and other systemic inflammatory disorders.

When using a QRISK3 risk score to inform treatment decisions in these populations, particularly if it is near the threshold for treatment, take into account other factors that may predispose the person to premature CVD that may not be included in calculated risk scores. [Adapted from NICE's guideline on cardiovascular disease: risk assessment and reduction, including lipid modification, recommendation 1.1.10]