Diabetes: statins for secondary prevention of CVD
Indicator
The percentage of patients with diabetes and a history of cardiovascular disease (excluding a history of haemorrhagic stroke) who are currently treated with a statin.
Indicator type
General practice indicator suitable for use in the Quality and Outcomes Framework.
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
This indicator aims to reduce cardiovascular risk and prevent future cardiovascular events. NICE's guideline on cardiovascular disease recommends treatment is started with atorvastatin 80 mg, whilst highlighting situations where a lower dose should be used. The indicator wording allows for choice of the appropriate dosage.
Source guidance
Cardiovascular disease: risk assessment and reduction, including lipid modification. NICE guideline NG238 (2023), recommendations 1.7.2 and 1.7.3
Specification
Numerator: The number of patients in the denominator who are currently treated with a statin.
Denominator: The number of patients with diabetes and a history of cardiovascular disease (excluding a history of haemorrhagic stroke).
Calculation: Numerator divided by the denominator, multiplied by 100.
Definitions: For the purposes of this indicator, cardiovascular disease is defined as angina, previous myocardial infarction, revascularisation, ischaemic stroke or TIA or symptomatic peripheral arterial disease. Existing QOF registers for coronary heart disease (CHD001), stroke or transient ischaemic attack (STIA001 excluding a history of haemorrhagic stroke) and symptomatic peripheral arterial disease (PAD001).
Exclusions: None.
Personalised care adjustments or exception reporting should be considered to account for situations where the patient declines, does not attend or if prescription of a statin is not appropriate (for example, non-atherosclerotic cardiovascular disease).
Expected population size:
Quality and Outcomes Framework for 2022 to 2023 shows that 2.0% of people in England are on the diabetes register and have a history of CVD (excluding haemorrhagic stroke): 195 patients for an average practice with 10,000 patients. To be suitable for use in QOF, there should be more than 20 patients eligible for inclusion in the denominator, per average practice with 10,000 patients, prior to application of personalised care adjustments.
Update information
Minor changes since publication
December 2023: We updated the source guidance section to link to updated recommendations on lipid lowering therapy in NICE's guideline on cardiovascular disease.
ISBN: 978-1-4731-5979-2