cardiovascular at risk register

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					          1.        Cardiovascular at-risk register service (“CV Service”)

                    1.1           The Provider shall ensure the following service aims are met:

                                  (a)   the establishment of a practice based at risk register using a risk
                                        assessment reporting tool; and

                                  (b)   annual reporting (early April) to the PCTs regarding:

                                        (i)     the number of Patients on the practice at-risk register; and

                                        (ii)    the number of Patients on the register who have had an annual
                                                review completed.

                    1.2           The Provider shall ensure that:

                                  (a) the following individuals are considered for formal CHD risk assessment:

                                          (i)   Patients with known clinical risk factors for CHD (e.g.
                                                hypertension, hyperlipidaemia);

                                          (ii) Patients with a strong family history of premature CHD.
                                               Clinicians should also consider the possibility of familial
                                               hyperlipidaemia; and

                                          (iii) Patients with a number of non-clinical risk factors (e.g.
                                                increasing age, male gender and smokers).

                                  (b)   the level of CVD risk should be estimated using an appropriate risk
                                        calculator, or by clinical assessment for people for whom an
                                        appropriate risk calculator is not available. For the avoidance of doubt,
                                        at risk is defined as a cardiovascular disease risk greater than 20%
                                        over 10 years;

                                  (c)   it opportunistically records information on risk factors for CHD in
                                        Patients. This should include details of their smoking status and family
                                        history of CHD; and

                                  (d)   Clinical Staff should periodically assess the blood pressures of Patients
                                        to screen for hypertension.

                    1.3           The Provider shall ensure that the CV Service includes but is not limited to:

                                  (a)     developing and maintaining an up-to-date register of all Patients who
                                          are at-risk of CVD. This will include all Patient details, the
                                          percentage risk and details of CVD risk factors;

                                  (b)     developing and maintaining appropriate and accurate records of
                                          Patient’s using the CV Service. Adequate recording should be made
                                          regarding the Patient’s clinical history, the action plan to address the
                                          risks and all follow-up arrangements;

                                  (c)     using the following Read Codes to support the development and
                                          maintenance of the cardiovascular at-risk register and facilitating
                                          monitoring. The Read Code for the CV Service as indicated in the



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                                         table below, shall be used for all data entries in order to allow
                                         accurate data collection:


                    Cardiovascular at-risk register – Read Code Summary
                    Joint British Societies cardiac risk score                                 388W
                    Joint British Societies cardiovascular disease risk less than ten          662k
                    percent over next ten years
                    Joint British Societies cardiovascular disease risk greater than 662n
                    thirty percent over next ten years
                    Joint British Societies cardiovascular disease risk ten percent to 662l
                    twenty percent over next ten years
                    Joint British Societies cardiovascular disease risk greater than 662m
                    twenty percent up to thirty percent over next ten years
                    Cardiovascular disease annual review                                       66f0
                    Cardiovascular disease interim monitoring                                  66f1
                    Cardiovascular disease monitoring not required                             66b0


                                  (d)    making changes to Read Codes as instructed by the PCT.

                                  (e)    ensuring that all Staff involved in providing any aspect of care under
                                         the CV Service have the necessary training and skills to do so;

                                  (f)    ensuring that the expertise of other professionals is drawn on where
                                         necessary. Any Health Care Professional involved in the care of
                                         Patients as part of the CV Service should be appropriately trained;
                                         and

                                  (g)    undertaking regular continual professional development (CPD).

                    1.4           The Provider shall be subject to an annual review of the CV Service which
                                  will include an audit of:

                                  (a)    the number of Patients on the at-risk register; and

                                  (b)    the number of Patients on the at-risk register who have had an annual
                                         review completed.

                    1.5           The Provider shall notify the PCT clinical governance lead of all emergency
                                  admissions or deaths of any Patient covered under this CV Service, where
                                  such admission or death is, or may be, due to the CV Service. This must be
                                  reported within 72 hours of the information becoming known to the
                                  practitioner via an agreed protocol. This is in addition to a practitioner’s
                                  statutory obligations.




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