Lipid Disorders


If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Chest pain (adult)

  • Suspected acute coronary syndrome
  • Suspected pulmonary embolism or aortic dissection
  • Suspected or confirmed endocarditis, myocarditis or pericarditis
  • Suspected ischaemic chest pain within 24 hours with any of the following concerning features:
    • severe or ongoing chest pain
    • chest pain lasting ten minutes or more
    • chest pain that is new at rest or with minimal activity
    • chest pain that is associated with severe dyspnoea
    • chest pain that is associated with syncope / pre-syncope
    • chest pain that is associated with any of the following signs:
      • respiratory rate > 30 breaths per minute
      • tachycardia >120
      • systolic BP < 90mmHg
      • heart failure / suspected pulmonary oedema
      • ST elevation or depression
      • complete heart block
      • new left bundle branch block 

 Atrial fibrillation

  • Atrial fibrillation / flutter with any of the following concerning features:
    • haemodynamic instability
    • shortness of breath
    • chest pain
    • syncope/pre syncope/dizziness
    • known Wolff-Parkinson-White
    • neurological deficit indicative of TIA/stroke

Heart failure

  • Acute or chronic heart failure with any of the following concerning features:
    • NYHA Class IV heart failure
    • ongoing chest pain
    • increasing shortness of breath
    • oxygen saturation < 90%
    • signs of acute pulmonary oedema
    • haemodynamic instability:
      • pre-syncope / syncope / severe dizziness
      • altered level of consciousness
      • heart rate > 120 beats per minute
      • systolic BP < 90mmHg
    • significant pulmonary or pedal oedema
    • recent myocardial infarction (within 2 weeks)
    • pregnant patient
    • signs of myocarditis
    • signs of acute decompensated heart failure


  • Hypertensive emergency (BP>220/140)
  • Severe hypertensive with systolic BP >180mmHg with any of the following concerning features:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
  • If suspected pregnancy induced hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible.

Murmur (adult)

  •  New murmur with any of the following concerning features:
    • haemodynamic instability
    • persistent or progressive shortness of breath (NYHA Class III – IV)
    • chest pain
    • syncope / pre-syncope / dizziness
    • neurological deficit indicative of TIA/stroke
    • abnormal ECG (e.g. LV hypertrophy, AF, LBBB, RBBB)
    • fever or constitutional symptoms suggestive of infection (eg endocarditis, acute rheumatic fever)
    • signs of heart failure


  • Palpitations with any of the following concerning features:
    • chest pain
    • shortness of breath
    • loss of consciousness
    • syncope / pre-syncope
    • persisting tachyarrhythmia on ECG

 Supraventricular tachycardia

  • Unresolved acute supraventricular tachycardia with any of the following concerning features:
    • syncope
    • severe dizziness
    • ongoing chest pain
    • increasing shortness of breath
    • hypotension
    • signs of cardiac failure
    • ventricular rate >120         

Syncope / pre-syncope

  • Syncope with any of the following concerning features:
    • exertional onset
    • chest pain
    • persistent hypotension (systolic BP <90mmHg)
    • severe persistent headache
    • focal neurological deficits
    • preceded by or associated with palpitations
    • known ischaemic heart disease or reduced LV systolic function
    • associated with SVT or paroxysmal atrial fibrillation
    • pre-excited QRS (delta waves) on ECG
    • suspected malfunction of pacemaker or ICD
    • absence of prodrome
    • associated injury
    • occurs while supine or sitting 


  • Pacemaker/ICD
    • delivery of 2 or more shocks by ICD in 24 hours
    • suspected pacemaker/defibrillator malfunction (with ECG evidence)
    • pacemaker/ICD device erosion
  • Bradycardia including any of the following:
    • symptomatic bradycardia
    • PR interval on ECG exceeding 300ms
    • second degree or complete heart block
  • Broad complex tachycardia
  • Suspected or confirmed endocarditis, myocarditis or pericarditis
Useful Management Information
  • Consider commencing statins depending on other cardiac risk factors
  • The Heart Foundation’s Lipid Management Guidelines provide some additional guidance for patient management
  • The QRISK®2 calculator is helpful in assessing cardiovascular disease risk
  • Patients with moderate hyperlipidaemia (total cholesterol 5 – 10mmol/L and/or triglycerides < 4mmol/L) may be referred to a general physician rather than a cardiologist depending on local services.
Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Total triglyceride > 20mmol/L in patient having had episode of pancreatitis in the previous 3 months (consider referring to Endocrinology if local services are available)
Category 2
(appointment within 90 calendar days)
Patients with prior ACS and:
  • LDL>5.0mmol/L; or
  • DLNC Score > 6 (ie likely heterozygous family history)
Category 3
(appointment within 365 calendar days)
  • Significantly raised LDL (> 4 mmol/L) in high CVD risk patients
  • Difficult to control LDL (> 3.3 mmol/L) in CHD patients with familial hypercholesterolemia
  • Severe mixed dyslipidemia (TC and TG totalling more than 10 mmol/L)

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service
Standard Referral Information

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential referral information

Without this information the referral will be returned

  • Details of all treatments offered and efficacy
  • Relevant previous medical history and co-morbidities (especially cardiovascular disease)
  • BP
  • ELFTs, HbA1c, TSH,
  • Recent (within 3 months) fasting lipid results (cholesterol/ triglyceride/ HDL-cholesterol/ LDL-cholesterol)
Additional Referral Information
  • Smoking and alcohol history
  • Family history of hyperlipidaemia
  • Previous lipid results (serial if available)
  • Any imaging confirming presence of cardiovascular disease
  • Coronary artery calcium score
  • Serum CK results
Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.


To provide feedback about contents on this website or general referral questions please email or phone 3413 7402.