IIF indicator and Familial Hypercholesterolaemia referrals

Dear colleague 

Re: CVD 04- Percentage of patients aged 29 and under with a total cholesterol greater than 7.5 OR aged 30 and over with a total cholesterol greater than 9.0 who have been referred for assessment for familial hypercholesterolaemia 

Last week across NEL we have seen a number of practices running a search to identify patients for this indicator and, as it says, have referred all of the patients they have found into the cardiologists. This has resulted in 92 referrals for A&G being received 2 days.  If every practice in North East London did this, it could result in 8700 referrals. Obviously, not ideal, especially at a time when we are looking to reduce referral numbers.

 There are many reasons why a patient would have a high cholesterol and there are other criteria which determines whether a patient may have FH. FH is a life threatening condition for the patient and their family. A referral can cause significant anxiety. 

We are working locally on a pathway to ensure the right people are being referred, This means doing the necessary work up, and determining the information to make a decision on whether it is likely that the individual is at high risk and needs a consultant opinion. In addition, we are looking at additional resource to support the clinics. 

The aim of the approach is to ensure the right patients get seen and correct diagnosis of FH are made, without increasing the burden on primary or secondary care. 

We ask that you kindly do not batch refer patients to secondary care as the indicator suggests but hold until we have developed the necessary guidance and resources which we anticipate will be with you by mid July 2022 

Best wishes


Dr Chris Carvalho & Dr Riyaz Patel