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CAMHS won't see you now

Every GP to get QRISK tool on their desktop

By Nigel Praities

Plans to put the QRISK cardiovascular risk score onto every GP desktop are being ramped up after a Department of Health-funded analysis has confirmed it outperforms Framingham on every measure.

A QRISK tool is now embedded in the EMIS system – used by over half of all GPs - and a software development kit is being made available by licence to other clinical system providers. QRISK is now part of QOF software.

NICE is now considering reviewing its lipid modification guidelines – published last year. If the institute finally opts for QRISK, Framingham will disappear from GP computers and the back pages of the BNF.

The new analysis – published in the British Medical Journal this month – found QRISK outperformed Framingham.

The University of Oxford researchers compared the 10-year risk of a major cardiovascular event in over one million patients on the general practice database, THIN.

They found the Framingham score – currently recommended by NICE – overestimated the risk of an event by 32% in men, 10% in women and 23% overall.

This compared with QRISK, which underestimated the risk of an event in men by 13%, 10% in women and by 12% overall.

A NICE spokesperson said: ‘We will now invite the National Collaborating Centre which developed this guideline to let us know whether they consider that this and other evidence, is sufficient to trigger an update ahead of the planned review in May 2011.'

Dr Christine A'Court, a GP in Carterton, Oxfordshire and CHD lead at Oxfordshire PCT, welcomed the rethink by NICE.

'We would all welcome clarification. You need to be confident you are conducting a valid risk assess-ment and you are giving the patient good advice,' she said.

Dr Chris Arden, a GP with a special interest in cardiovascular disease, said QRISK should be used for new patients, and not in re-assessing patients given a Framingham risk score.

‘I am in favour of a more contemporary risk assessment tool. QRISK has been validated in a pre-treatment population and should not be used to assess risk in patients already being treated.'

Professor Julia Hippisley-Cox, QRISK researcher and professor of primary care at the University of Nottingham, said: 'We believe this formula has the potential to save many thousands of lives, by helping clinicians to more accurately predict those at risk of developing cardiovascular disease.'

How QRISK pushed Framingham aside

July 2009: Pulse reveals one SHA and several PCTs opting for QRISK over Framingham

November 2008: Pulse reveals the DH has funded an independent analysis of QRISK and has held se-cret discussions with NICE

May 2008: Pulse reveals NICE has backed a modified version of Framingham in its lipids modification guidance

March 2008: British Heart Foundation warn that QRISK needs further evaluation before it can replace Framingham

July 2007: QRISK is launched and developers call for it to be adopted as soon as possible

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