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Framingham not cardiovascular tool of choice, says NICE

By Adam Legge

NICE has withdrawn its support for Framingham as the cardiovascular risk tool of choice in a lipid guidance update - but stopped short of explicitly recommending QRISK as a replacement.

The institute said the guidance recommending Framingham has been withdrawn ‘so that the decision could be left to the NHS locally to use the method best suited to their requirements.'

The NICE announcement comes a week after Pulse exclusively reported Professor Roger Boyle, the national director for heart disease and stroke, had strongly endorsed QRISK.

He said: ‘It seems to me rather perverse to use a risk engine that does not factor in deprivation when we know it is such a powerful determinant.'

He also said the fact that QRISK – embedded in EMIS systems – would have to paid for by some trusts had stopped the Department of Health mandating its use.

QRISK has also been backed by the RCGP. College chair Professor Steve Field told a conference last year: ‘It's the risk classification that should be used uniformly across the vascular checks programme and should go into QOF. It's based in the UK, takes into account ethnicity and it's bloody good.'

A Pulse investigation earlier this year suggested about half of PCTs are making QRISK available – most in conjunction with Framingham.

Dr Fergus Macbeth, director of the centre for clinical practice at NICE, defended the decision not to endorse one tool over the other.

He said: 'Today's decision acknowledges that both Framingham and QRISK have positive features to recommend them and that the field continues to evolve rapidly.'

‘Until, and if, the evidence shows a clear benefit of using one assessment tool over the other we have recommended that healthcare professionals use the tool that best suits their requirements.'

NICE has withdrawn its support for Framingham as the cardiovascular risk tool of choice in a lipid guidance update. NICE has withdrawn its support for Framingham as the cardiovascular risk tool of choice in a lipid guidance update.

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