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Online risk score can guide GPs' cardiovascular treatment and referral

By Nerys Hairon

A new risk-score for angina can guide GPs' decisions on treatment and referral by accurately predicting cardiovascular outcomes, a study reports.

Researchers uncovered a

10-fold difference in risk of death, myocardial infarction and disabling stroke in patients with the highest and lowest scores.

The study, which assessed 16 risk factors in 7,311 patients, stratified the combined, five-year risk into 10ths, and found it ranged from 4 per cent at the bottom to 35 per cent at the top.

The researchers, whose study is published online by the BMJ this week, have developed a web tool based on the risk calculations, which they said GPs could use to determine treatment strategies.

Study researcher Professor Keith Fox, professor of cardiology at the University of Edinburgh, said: ‘The results are really very important because they show there is almost a 10-fold difference in the risk of death depending on characteristics. I think it was a surprise that there was such a range in risk.

‘We're developing an electronic version which will be very easy to run and could help inform the GP about treatment and referral decisions.'

Fellow researcher Professor Stuart Pocock, professor of medical statistics at the London School of Hygiene and Tropical Medicine, said the web tool put patients in one of five categories – very low risk, low risk, medium risk, high risk and very high risk.

‘If a patient is at low risk the GP might feel they can stay sensibly within the primary care team but a high risk may encourage them to feel they should be in touch regularly with the specialist cardiology [department].'

Dr John Ashcroft, CHD lead at Erewash PCT, said the online risk calculator was ‘very nice' and that he had already added it to his desktop.

‘It could be quite helpful at [guiding] doctors on whom to concentrate their time and resources. You may want to be more aggressive with cholesterol-lowering in a patient whose risk is high, compared with one with moderate risk.'

But Dr John Pittard, CHD lead at North Surrey PCT, said the risk score could be useful in an electronic version, but may be ‘best suited to hospital outpatients where more data is available in practice'.

To access the provisional web tool, see:

Risk factors with angina

The top 10

1 Age

2 Left ventricular ejection fraction

3 Smoking

4 White blood cell count

5 Diabetes

6 Casual blood glucose concentration

7 Creatinine concentration

8 Previous stroke

9 At least one angina attack a week

10 Coronary angiographic findings (if available)

Source: BMJ 10 Oct, early online publication

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