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At the heart of general practice since 1960

Major change to statin guidance expected as QRISK gets green light

By Nigel Praities

A Department of Health-funded analysis signals a sea-change in the way GPs assess thousands of patients for statin treatment, with researchers recommending the Framingham risk score is consigned to history.

The independent analysis finds the UK general practice derived score QRISK outperforms Framingham on every measure and should be used routinely to assess cardiovascular risk.

Pulse revealed earlier this year that the Department of Health was keen to roll-out QRISK and that publication of this analysis – published in the British Medical Journal this week – was likely to trigger a review of NICE guidance on how GPs assess eligibility for primary prevention.

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.

The researchers concluded that these results demonstrated that QRISK more accurately predicted the cardiovascular risk of UK patients.

‘We have assessed the performance of QRISK against the current NICE recommended model and have provided evidence to support the use of QRISK in favour of the Anderson Framingham equation,' they said.

Pulse revealed in February that officials at NICE had urged the Department of Health to publish this analysis so they would have reason to look again at their recommendations on cardiovascular risk assessment.

Documents released to Pulse under the Freedom of Information Act earlier this year revealed Philip Alderson, NICE associate director, said to heart tsar, Dr Roger Boyle: ‘If this was in the public domain it would give us sufficient reason to trigger an update.'

The development also comes weeks after Pulse revealed a growing split in the Government's vascular screening programme, as one whole SHA and several other PCTs opt for QRISK over Framingham.

Professor Julia Hippisley-Cox, QRISK researcher and professor of primary care at the University of Nottingham, said: 'We are delighted to receive another strong endorsement of the value of QRISK in assessing the risk of heart disease in the UK population.

'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.'

A major change to statins guidance is now expected A major change to statins guidance is now expected

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