Claims about QRISK do not serve debate
I am writing to express my concern at important factual errors in Professor Paul Durrington's article for your recent debate (‘Is it time to turn our back on Framingham?', pulsetoday. co.uk/debates).
It is particularly concerning as Pulse had been warned prior to publication that the article contained serious errors.
The most serious error relates to external independent referees appointed by the NICE guideline development group to report on whether a Framingham-based approach or QRISK was the most appropriate CVD risk calculator for England and Wales.
Professor Durrington says: ‘NICE did originally propose to use QRISK, but external referees expressed major concerns that its adoption would be premature.' This is wrong and an inaccurate representation of the referees' opinion.
In contrast to Professor Durrington's statement, Professors Richard Peto, Doug Altman and Rod Jackson all concluded QRISK was the best choice.
NICE then went on to overrule the experts on the basis of comments from a minority of interested stakeholders and no new evidence – recommending its own unique and untested modification of two Framingham equations.
Second, Professor Durrington says: ‘Lipid data were available (in QRISK2) in only about a quarter of patients and CVD events collected over only six years or so.' This is wrong too.
The proportion of women and men in the derivation cohort with a recorded total cholesterol/HDL ratio was 34.3% and 32.4% respectively – a third, not a quarter – and 437,676 people were followed up for more than 10 years.
QRISK2 has been developed from GP data, by GPs, for GPs. Despite appropriately modelling the risks associated with ethnicity, family history, social deprivation and being on hypertension treatment, and being fairer and more accurate than other approaches, it has been resisted by some who wish to maintain the status quo.
I recognise there is a spectrum of views on this issue, but the debate is not served by publication of erroneous statements.
Dr Peter Brindle
QRISK2 co-author and a GP in Bristol
Editor's note We regret that in publishing Professor Durrington's article we inadvertently disseminated factual inaccuracies about QRISK. We would like to apologise to Dr Brindle and the QRISK team.