Lithuanian CVD Implementation Guide
0.0.1 - ci-build Lithuania flag

Lithuanian CVD Implementation Guide, published by Lithuanian Medical Library. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7LT/ig-lt-cvd/ and changes regularly. See the Directory of published versions

Questionnaires

ESPBI electronic forms as Questionnaires

Lithuanian CVD prevention and early diagnosis programme documentation defines two main electronic forms for ESPBI: the patient CVD risk assessment questionnaire (Form 1) and the CVD prevention measures plan including a follow-up achievement evaluation block (Form 2).

This IG provides illustrative FHIR Questionnaire definitions and matching QuestionnaireResponse examples so implementers can align form capture with FHIR without replacing the structured Observation and CarePlan profiles used elsewhere in the guide.

The Questionnaires use groups (item.type = #group) with stable linkIds so production systems can extend items to the full national field set. Conditional sub-items use enableWhen logic.

Form 1 — CVD risk assessment questionnaire

FHIR artefacts:

Group: Context

linkId Label Type Required Maps to
evaluation-datetime Evaluation date and time dateTime yes CVDRiskAssessmentLtCvd

Group: Accompanying chronic diseases

linkId Label Type Required Maps to
chronic-condition-summary Relevant chronic conditions text — CvdChronicConditionLtCvd

Group: Risk factors

linkId Label Type Required Maps to
risk-factor-hypertension Arterial hypertension coding yes RiskFactorStatusLtCvd
risk-factor-dyslipidemia Dyslipidemia coding yes RiskFactorStatusLtCvd
risk-factor-diabetes Diabetes coding yes RiskFactorStatusLtCvd
risk-factor-glucose-tolerance Glucose tolerance / fasting glucose disorder coding yes RiskFactorStatusLtCvd
risk-factor-familial-hypercholesterolemia Familial hypercholesterolemia coding yes RiskFactorStatusLtCvd
risk-factor-smoking Smoking coding yes TobaccoUseLtLifestyle (Lifestyle IG)
↳ smoking-duration-years Smoking duration (years) decimal — TobaccoUseDurationLtLifestyle — shown when Smokes
↳ smoking-type Form of smoking coding (repeats) — TobaccoTypeUsedLtLifestyle — shown when Smokes
risk-factor-physical-activity Physical activity coding yes PhysicalActivityLtLifestyle (Lifestyle IG)
risk-factor-nutrition Nutrition coding yes NutritionLtLifestyle (Lifestyle IG)
risk-factor-alcohol Alcohol consumption coding yes AlcoholConsumptionLtLifestyle (Lifestyle IG)
↳ audit-c-score AUDIT / AUDIT-C test result decimal — AuditCLtLifestyle — shown when Alcohol: Yes
risk-factor-family-cvd Family history of early CVD or early cardiac death coding yes FamilyHistoryCvdLtLifestyle (Lifestyle IG)
risk-factor-family-diabetes Family history of diabetes coding yes FamilyHistoryDiabetesLtLifestyle (Lifestyle IG)

Answer options for risk factor items: No / There is, untreated / There is, treated (hypertension, dyslipidemia, diabetes, glucose tolerance); No / There is (familial hypercholesterolemia); Did not smoke / Smokes / Smoked before (smoking); Sufficient / Insufficient (physical activity); Balanced / Unbalanced (nutrition); No / Yes / Unknown (alcohol, family history items).

Group: Objective condition and investigations

linkId Label Type Required Maps to
height-cm Height (cm) decimal yes BodyHeightLtVitalSigns (VitalSigns IG)
weight-kg Weight (kg) decimal yes BodyWeightLtVitalSigns (VitalSigns IG)
waist-cm Waist circumference (cm) decimal yes WaistCircumferenceLtVitalSigns (VitalSigns IG)
bp-systolic Systolic blood pressure (mmHg) decimal yes BloodPressurePanelLtVitalSigns (VitalSigns IG)
bp-diastolic Diastolic blood pressure (mmHg) decimal yes BloodPressurePanelLtVitalSigns (VitalSigns IG)
heart-rate Heart rate (bpm) decimal yes HeartRateLtVitalSigns (VitalSigns IG)
bmi-calculated BMI (kg/m², auto-calculated) decimal yes BmiLtVitalSigns (VitalSigns IG)
abdominal-obesity Abdominal obesity (men ≥102 cm, women ≥88 cm) coding yes WaistCircumferenceLtVitalSigns — use interpretation for obesity code
obesity-bmi Obesity (BMI ≥25) coding yes BmiLtVitalSigns (VitalSigns IG)

Group: Lipidogram

linkId Label Type Required Maps to
lipid-tc Total cholesterol (mmol/l) decimal yes TotalCholesterolLabLt (Lab IG)
lipid-hdl HDL cholesterol (mmol/l) decimal yes CholesterolHdlLabLt (Lab IG)
lipid-non-hdl Non-HDL cholesterol (mmol/l) decimal yes CholesterolNonHdlLabLt (Lab IG)
lipid-ldl LDL cholesterol (mmol/l) decimal yes CholesterolLdlLabLt (Lab IG)
lipid-tg Triglycerides (mmol/l) decimal yes TriglyceridesLabLt (Lab IG)

Group: Risk estimate and group

linkId Label Type Required Maps to
score2-percent SCORE2 cardiovascular risk (%) decimal — CVDRiskAssessmentLtCvd
metabolic-syndrome Metabolic syndrome (≥3 of 5 NCEP ATP III criteria) coding yes MetabolicSyndromeLtLifestyle (Lifestyle IG)
risk-group-cvd Risk group for heart and vascular diseases coding yes RiskGroupObservationLtCvd
albumin-creatinine-ratio Albumin/creatinine ratio (patients with diabetes) decimal — AcrLabLt (Lab IG)

Group: Extended parity — migration mapping

Optional items covering fields present in the DSTU1 migration mapping table but not duplicated in the core groups above. All are required = true where the programme mandates the value.

linkId Label Required Maps to
mig-encounter Encounter (visit id / context) — EncounterLt (Base IG)
mig-practitioner-role PractitionerRole (workplace / specialist) — PractitionerRoleLt (Base IG)
mig-heart-rate Heart rate (bpm) — HeartRateLtVitalSigns
mig-bmi BMI (kg/m²) — BmiLtVitalSigns
mig-glucose-fasting Fasting glucose (mmol/l) yes GlucoseVenousLabLt (Lab IG)
mig-hba1c HbA1c (%) yes Hba1cLabLt (Lab IG)
mig-creatinine Creatinine yes CreatinineTestLabLt (Lab IG)
mig-egfr eGFR yes EgfrLabLt (Lab IG)
mig-alcohol Alcohol consumption (summary) — AlcoholConsumptionLtLifestyle
mig-physical-activity Physical activity (summary) — PhysicalActivityLtLifestyle
mig-nutrition Dietary habits / nutrition — NutritionLtLifestyle
mig-family-cvd Family history of CVD — FamilyHistoryCvdLtLifestyle
mig-referral Referral (cardiology / service) — ServiceRequestLt (Base IG)
mig-follow-up-appointment Follow-up visit (appointment) — AppointmentLt (Base IG)
mig-achievement-round Achievement evaluation (narrative) — ObservationLt (Base IG)
mig-chronic-additional Additional chronic conditions — CvdChronicConditionLtCvd

Form 2 — Prevention plan and achievement evaluation

FHIR artefacts:

Group: Plan

linkId Label Type Required Maps to
plan-created-datetime Plan creation date and time dateTime yes CarePlanLtCvd
plan-risk-group Risk group for heart and vascular diseases (plan) coding yes RiskGroupExtLtCvd
plan-target-ldl Target LDL cholesterol coding yes CarePlanLtCvd — options: <2.6 / <1.8 / <1.4 mmol/l
plan-target-bp Target blood pressure: 120–129/<80 mmHg display — CarePlanLtCvd
plan-smoking-cessation Quitting smoking (interventions) coding (repeats) — CarePlanLtCvd — Pharmacological / Behavior change tools

Group: Lifestyle and weight

linkId Label Type Required Maps to
plan-physical-activity Physical activity plan coding — PhysicalActivityLtLifestyle (Lifestyle IG)
plan-target-bmi Target BMI (kg/m²) decimal yes BmiLtVitalSigns (VitalSigns IG)
info-healthy-nutrition Healthy nutrition — Mediterranean diet recommended; reduce salt, saturated fats, and added sugar display — —
info-healthy-weight Healthy weight — target BMI < 25 kg/m²; waist men < 94 cm, women < 80 cm display — —
info-regular-medication Regular medication — take all prescribed medications (statins, antihypertensives) regularly and as directed display — —

Group: Achievement evaluation

linkId Label Type Required Maps to
achievement-datetime Achievement evaluation date and time dateTime — ObservationLt (Base IG)
achievement-ldl-mmol Achieved LDL cholesterol (mmol/l) decimal — CholesterolLdlLabLt (Lab IG)
achievement-ldl-target-met Has the target LDL been achieved? boolean — CarePlanLtCvd
achievement-bp-systolic Current systolic blood pressure (mmHg) decimal — BloodPressurePanelLtVitalSigns
achievement-bp-diastolic Current diastolic blood pressure (mmHg) decimal — BloodPressurePanelLtVitalSigns
achievement-bp-target-met Has the target BP been achieved? boolean — CarePlanLtCvd
achievement-smoking-quit Smoking cessation achieved boolean — TobaccoUseLtLifestyle (Lifestyle IG)
achievement-height-cm Height (cm) decimal yes BodyHeightLtVitalSigns (VitalSigns IG)
achievement-weight-kg Weight (kg) decimal yes BodyWeightLtVitalSigns (VitalSigns IG)
achievement-bmi Achieved BMI (kg/m², auto-calculated) decimal yes BmiLtVitalSigns (VitalSigns IG)
achievement-comments Comments from the achievement evaluator text — ObservationLt (Base IG)

Mapping to profiles (FHIR R5)

The Questionnaires use optional canonical item.definition (StructureDefinition URI) on each item and separate ConceptMap resources for full cross-IG narrative: each row maps a linkId to a target profile code with target.comment (StructureDefinition URLs, example instance ids, CI Build links).

When to use QuestionnaireResponse vs Observations

Approach Typical use
Questionnaire / QuestionnaireResponse Screen-faithful capture of form answers; rapid alignment with ESPBI UI; export of filled forms.
Observation, Condition, CarePlan Clinical interoperability, decision support, SCORE2 and risk group semantics, CarePlan goals and activities, longitudinal follow-up.

In practice, a system might persist QuestionnaireResponse for auditing and derive Observations and CarePlans for reporting and exchange. The CVD report model (DiagnosticReport + Composition) is not required to reference Questionnaire resources; the two approaches can coexist.

Cross-IG examples (CI Build)

Measurement Link
Blood pressure Observation: Blood Pressure
Body height Observation: Body Height
Tobacco use Observation: Smoking Status – Current Smoker
Alcohol consumption Observation: Alcohol Consumption – No
Physical activity Observation: Physical Activity – Below Recommendation
Nutrition Observation: Nutrition – Balanced
Family history CVD Observation: Family History CVD – Positive

Continuous integration builds: LT VitalSigns IG · LT Lifestyle IG · LT Lab IG