New CVD risk score set to usurp Framingham
The days of the Framingham risk score could be numbered after the development of a brand new score that successfully corrects for family history and deprivation.
ASSIGN is already set for inclusion in new Scottish guidance and will also be considered by NICE for possible introduction next year, writes Daniel Cressey.
The score will be incorporated into GP computer systems, which will automatically enter a patient's postcode in order to adjust for deprivation.
A new study, by leading NICE adviser Dr Peter Brindle and experts for the Scottish Intercollegiate Guidelines Network, found the score effectively targeted treatments at those most in need.
ASSIGN performed only slightly better than Framingham overall, correctly placing patients above the 20 per cent 10-year risk threshold in 83 per cent, compared with 79 per cent, of cases.
But the score – based on UK data and developed by the SIGN group on risk estimation – was fairer than Framingham. It directed treatment at a higher proportion of patients from socially deprived groups, according to the study of 13,000 people, published online by Heart.
Dr Brindle, a GP in Bristol, said: 'A couple of studies have demonstrated that Framingham scores predicted risk differently in people from different backgrounds. What ASSIGN does is introduce a social deprivation measure and reduce this inequality.
'At this stage NICE is aware of the difficulties of the Framingham score and considering all options, of which ASSIGN is one.'
Dr Paramjit Gill, a member of the NICE guideline group on lipid modification, said the institute would need to look carefully at the new score.
Dr Gill, clinical senior lecturer at the University of Birmingham and a GP in the city, said: 'If there is a new tool, that can
only be for the better. Any new research should be considered by all policymakers.'
GPs welcomed the development of ASSIGN.
Dr Rob Barnett, secretary of Liverpool LMC, said: 'Everyone knows Framingham is not good. I'm sure things that try to quantify the problem better are needed.'