Advice and Guidance

LDLc can be calculated, if the result is not available from the laboratory by using the Friedwald formula below:

LDL Cholesterol = Total Cholesterol - HDL - (Fasting TG divided by 2.2)

Note: Fasting TGs are necessary if TGs greater than 4.

These are identical as can be seen from the following worked example where total cholesterol is 4.9, HDL is 0.06 and Triglyceride is 1.51 mmol/l:

Using ESH Task Force version we get: LDL cholesterol = 4.9 - 0.06 -(0.45 X 1.51) = 4.1605 mmol/l

Using the Heartwatch version we get: LDL cholesterol = 4.9 - 0.06 - (1.51/2.2) = 4.1536 mmol/l

Here is the description of the above as it appears in the ESH Task Force document:

Most laboratories measure cholesterol, triglycerides and the part of cholesterol carried in HDL, namely HDL cholesterol. With these three measurements, the part of cholesterol carried in LDL can be calculated according to the Friedewald formula: In mmol/l^-1:
LDL cholesterol = total cholesterol - HDL cholesterol - (0.45 x triglycerides)

In mg/dl^-1:
LDL cholesterol = total cholesterol - HDL cholesterol - (0.2 x triglycerides)

The calculation is based on the assumption that triglycerides are less than 5mmol/l^-1 (450mg/dl-1).

The accuracy of this estimation of LDL cholesterol can be reduced due to a summation of possible analytical errors in the various lipid measurements. For the time being, however, the Friedewald calculation is cheaper and more reliable estimation of LDL cholesterol than commercially available direct measurements of LDL based on immunoseparation^[383].

Reference:
^[383] Yu HH, Ginsburg GS, Harris N, Rifai N. Evaluation and clinical application of the direct low-density lipoprotein cholesterol assay in normolipidemic and hyperlidemic adults.
Am J Cardiol 1997; 80: 1295-9.

Here is the description of the above as it appears on page 19 of the Heartwatch Reference Guide, which was supplied on CD to participating practices:

LDLc can be calculated, if the result is not available from the laboratory by using the Friedwald formula below:

LDL Cholesterol = Total Cholesterol - HDL - (Fasting TG divided by 2.2)

Note: Fasting TGs are necessary if TGs greater than 4.

Payment for patient visits will be made by the GMS Payments Board approximately six weeks following the data returns.

Take the October payment as an example:

• Any data returned up to and including 30 September will be paid in October
• Any data returned in the month of October and up to and including 31 October will be paid in November
• 7th of every month: Instruction of payment sent to the GMS Payments Board
• 14th of every month: Payment sent to GP

There is no deadline for the registration of the 15 patients. GPs will receive their bonus payment of €1,250 regardless of the time span of their patient registration whether they register all 15 over a month or over the space of six months. The patients must be registered complete with Continuing Care Forms.

You do not need to have 15 patients registered in order to receive any payments. You will receive payment for each patient registered (complete with Continuing Care Form) regardless of whether or not you have reached the minimum of 15; however, you will not receive the bonus payment until you have registered the minimum of 15.

Testing for Microalbuminuria is only mandatory in the MHB region. While we strongly recommend that GPs test for it, it is not compulsory and if GPs think it is too expensive then they are permitted to leave it out. Testing for Protinuria should be carried out on all diabetic patients.

When calculating the worst ever risk factor, take the age of the patient 'today'. The patient can therefore be told that this is what their risk factor index would be, if they did not improve their status with regard to smoking, cholesterol, blood pressure etc.

We only want an ECG record as an event if they are referred outside the practice as we only want this information to detail the number of referrals made. ECGs within the practice should not be included.

This is optional, it is at the discretion of the GP whether or not to complete the Personal Record Card.

The practices may enter the value 29.99 if the cholesterol does not need to be checked on the patient's second visit.

Fasting glucose can be measured on the second visit. Alternatively, if it has been measured within the previous three months, then use this figure.

If targets are met on the first visit, the test will not have to be done again on the second visit. However, most fields in R2 are mandatory.

If a patient dies at home the events form should be completed by entering the local hospital; then under hospital admission, click the "no" box. In this way we will be able to see which deaths occurred outside the hospital.

If the medication of a patient is changed to another drug in the same class then the reason for the change should be assessed. If the reason for changing is that the control of the individual risk factor is sub optimal and a more potent response is being sought then the change of the drug should be recorded as an "increased dose". If the response is because of side effects but the patient is adequately controlled, then this should be recorded as "dosage maintained".

Angina should be captured as an event if its of clinical significance ie new onset angina, unstable angina, angina episode needing hospital admission. Therefore, if the patient is known to suffer with angina and has an episode managed in the GP surgery or at home this should not be recorded as an event.

The Interim Tool R2 will not allow you to complete the form without filling in a value for 'Waist Circumference'. In this instance, input the value as 11. On the patient's second visit, measure the 'Waist Circumference' and input the value on the continuing care form as usual.

Yes - The INDC recommends that you use a stand-alone computer with internet connection for transferring your reports to the data centre. However, if for any reason you must use a different computer for connecting to the internet than the computer with the Interim Software, the INDC can provide step-by-step instructions on copying files from one computer to another to send your data returns to the INDC.

Installing Interim Tool R_2 for the first time

• Insert CD_ROM and allow to auto-install
• Once installed, open c:\program files\Heartwatch_R2\Heartwatch_R2
• If Heartwatch Release 1 has already been installed and used, then 'Import Heartwatch Data'
• If Heartwatch Release has not previously been installed, then 'Register Practice'

Then, before you login...

• Click Tool -> Options
• General Tab -> 'Name Autocorrect' Section
• Un-tick 'Track Name Autocorrect Info'
• 'Apply' and 'Close'
• Exit Programme
• Open again, this time logging in
• Use the tool as normal

The problem will now be solved.

Yes. It is always very important to back up files.

• Go to My Computer 
• The files you will need to back up for Heartwatch are located in the following folder: Local Disk C:\Program Files\Heartwatch_R2
• Save the 'Heartwatch_R2' folder, including all of its files on to a CD Rom or Zip disk.

If you are using back-up software, choose the 'Heartwatch_R2' folder to be backed up.

The following table shows the values to be entered on the interim tool in these circumstances:

It is important to note that these figures will act as an indicator that the particular piece of data was not required on this occasion. In the "data cleansing process" this data will be changed to ensure the database is not corrupted with inaccurate information.