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Independents' Day

It’s like the BP row all over again

Cardiovascular experts are a prickly lot.

Cardiovascular experts are a prickly lot.

The heavyweights from NICE and the British Hypertension Society spent the best part of two years in a verbal slanging match over drug choice in hypertension.

Now they're at it again, exchanging academic slights and intellectual headbutts over the latest guidance from NICE, this time on the risk score to be used in assessing patients for statins.

On this occasion it is NICE that is presenting itself as the force of progress, promoting the attractive, UK-based but relatively untested QRISK, whereas experts from the BHS and Heart UK insist on sticking with the old stalwart, the Framingham score.

So who's right? On one hand, QRISK has, aptly enough, the feel of a gamble for NICE, given it was only described in a peer-reviewed journal for the first time seven months ago, and has barely been used in the clinic. On the other, Framingham may be tried and tested, but its flaws have become only too apparent over the years, and its opponents accuse it of systematically embedding healthcare inequalities.

Secondary care snobbery

There's more than a hint of secondary care snobbery in the way consultants have turned their noses up at QRISK, which was developed by a team of

GPs. But what matters more than rivalry between specialisms or academic pride is that NICE gets its guidance right, and avoids leaving GPs confused in the process.

The institute, this time around, cannot afford to keep GPs guessing for two years before reaching grudging agreement with its critics. It needs to sit down with the member bodies of the Joint British Societies sooner rather than later. On such a central element of general practice as use of statins, GPs need guidance that everyone can trust.

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