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New CVD ethnicity risk tool

UK primary care experts have developed a new online risk calculator to allow GPs to accurately adjust Framingham for different ethnic groups.

By Daniel Cressey

The calculator, titled Ethrisk, is under consideration as part of a NICE review of the role of the Framingham risk score in general practice.

It is the first time GPs have had the opportunity to recalibrate Framingham to UK data on risk of CHD and CVD in different ethnic populations.

Dr Peter Brindle, who led development of the calculator and is the institute's leading expert on CVD risk, told Pulse: 'There is certainly a big gap in the market. Ethrisk does provide the standard score ­ it just gives a bit of extra information if your patient doesn't fit that Framingham model.'

Dr Brindle, head of research strategy at Bristol PCT and a GP in the city, added: 'It's the best we have at the moment. If I was looking to refine my risk assessment I would use Ethrisk.'

The calculator was developed with funding from the British Heart Foundation and uses data from a variety of sources including the Health Survey for England and Office for National Statistics. Its release comes after a raft of studies strongly criticising the Framingham charts (see box, right).

Dr Colin Fischbacher, a collaborator on the project and consultant in public health medicine at the University of Edinburgh, said: 'There's a big problem with the existing calculations.

'The information we have is mainly based on white US populations.

'Many people are being greatly undertreated, and their true CHD risk is being greatly underestimated, because doctors are using tools that really don't work in these groups.

'The BHS has recommended people take the risk for white [patients] and multiply it by 1.5. This work has been an attempt to refine our instruments.'

Dr Peter Randall, CHD lead for Isle of Wight PCT, said: 'I would find Ethrisk very useful. The difficulty with Framingham is the various bodies aren't giving a clear lead about what we should be doing.'

Some GPs remain sceptical over the calculator, arguing large-scale UK cohort studies are needed before risk can accurately be assessed

How the Framingham score came in for criticism

June 2004

Two studies show Framingham substantially underestimates risk of CHD in diabetes

February 2005

Dr Brindle's group assesses risk in different ethnic groups as precursor to Ethrisk

September 2005

SIGN-commissioned study shows Framingham underestimates relative risk of deprived patients by up to 300 per cent

October 2005

Study presented to NICE suggests adjusting Framingham could increase eligible patients seven-fold

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