New CVD risk tool to be considered by NICE
By Cato Pedder
GPs could soon be using a new scoring system for cardiovascular risk assessment after NICE came under strong pressure to alter draft guidance that continues to endorse Framingham.
The institute is set to consider a risk score released last week that is based exclusively on data from UK general practice.
The score, named QRISK, was drawn up using data from 1.28 million patients and takes into account factors ignored by Framingham, including deprivation, family history, BMI and treatment with anti-hypertensive drugs.
Its developers, who include a leading adviser to NICE, claimed it would be substantially better than Framingham and should be adopted as soon as possible.
Dr Peter Brindle, a GP in Bristol who advises the institute on CVD risk assessment, told Pulse he thought QRISK was the first significant advance on Framingham. 'My view is that QRISK offers new advantages over Framingham.
The sooner people look at it and decide it is better and choose to use it the better.' But he advised GPs should hold off from using the system until national guidance was available.
New research outlining the risk score was published too late for inclusion in the draft NICE guidance on lipid modification, but is now set to be considered for the final document.
Its release last week online by the BMJ sparked controversy, with reports that differences between QRISK and Framingham meant thousands were receiving statins unnecessarily.
Researchers tracked patients for 12 years and found QRISK predicted 8.5% of patients to be at 20% or higher CVD risk over 10 years, compared with 13% when using Framingham and 14% when using the Scottish ASSIGN tool.
QRISK also identified a different group of patients from Framingham, with fewer men and more women being classified at high risk.
It comes just two weeks after NICE draft guidance advised GPs continue to use Framingham, despite admitting it needed adjusting for family history, deprivation and ethnicity.
Professor Julia Hippisley-Cox, professor of clinical epidemiology at the University of Nottingham, who led the new study, said: 'We think QRISK is better calibrated for the UK population and better identifies those who are likely to benefit or not from treatment.'
Work is currently under way to validate the system using a database other than EMIS, on which it was based.Pulse - QRISK v Framingham