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Avoiding taxing locum problem

A guideline review group is considering proposals to scrap the Framingham risk score and replace it with a system based on UK data, Pulse has learned.

The Scottish Intercollegiate Guidelines Network has decided to act after a study it commissioned revealed the dramatic extent of Framingham's failures.

The research, presented to a SIGN meeting this week, found Framingham underestimates relative risk for deprived patients by up to 300 per cent. Deprived women were particularly likely to lose out.

SIGN is setting up a review group to discuss proposals including new scores based on UK cohort data, adjustment of risk by postcode or practice deprivation score and addition of years in age to deprived or ethnic minority patients.

NICE will also re-evaluate risk estimation as part of its guidance under development on lipid modification.

Professor Hugh Tunstall-Pedoe, leader of the new study and director of the University of Dundee's cardiovascular epidemiology unit, said: 'Our results are very clear and very powerful. On the grounds of both efficiency and equity something needs to be done.'

Professor Tunstall-Pedoe said his results, published online by Heart, had been discussed at the SIGN meeting and the majority who had expressed a clear opinion fav-oured a new risk score.

Dr James Grant, chair of the SIGN CHD prevention guideline group and a GP in Auchterader, Perthshire, said: 'The outcome was we are keen to give social deprivation a higher profile in risk estimation. A group will look at how that is done, if it's a question of redoing a risk score or if there's any other way of integrating that into risk assessment.'

Dr Peter Brindle, adviser to NICE and SIGN on lipid modification and a GP in Bristol, said his own, unpublished, research had reached a similar conclusion. He said deprivation modifications would 'increase workload considerably' and require additional resources.

Professor Tunstall-Pedoe advised GPs to 'err on the side of generosity' in deprived patients. GP CHD experts said GPs should multiply risk by 1.5 for south Asian patients.

By Daniel Cressey

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