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New deprivation adjusted risk score ousts Framingham

The Framingham risk charts are to be consigned to history and replaced by a new cardiovascular risk score that adjusts for patient deprivation.

The new score is set to transform GP assessment of cardiovascular risk following a raft of recent studies revealing serious inadequacies in Framingham.

GPs will gain electronic access to the risk assessment ­ which corrects Framingham by a patient's six-digit postcode ­ with forthcoming Scottish guidance on managing CVD.

The National Screening Committee will meet the Scottish CMO this month to discuss using the score as a central plank of the planned UK-wide cardiovascular screening programme.

The Scottish Intercollegiate Guidelines Network document ­ currently in final draft form ­ also heralds a tough new era of cholesterol management. It sets a target of 4mmol/l for all patients treated with statins.

NICE is considering the recommendations and has a 'memorandum of agreement' with SIGN to ensure the two bodies avoid clashes in their advice.

Dr James Grant, chair of the guideline development group and a GP in Auchterarder, Perthshire, said: 'It has been a long and difficult process. We are hoping to produce ­ after a huge amount of work ­ a correction for deprivation.

'What we are doing will have an impact beyond Scotland.'

It follows multiple studies reported by Pulse that found Framingham drastically underestimated risk in ethnic minorities and deprived populations.

Sir Muir Gray, director of the National Screening Committee, told Pulse: 'It's a very important initiative. SIGN is part of the knowledge sources we use. We're looking forward to a briefing from the Scottish CMO.'

Dr Rubin Minhas, a member of the NICE lipid modification guideline development group and a GP in Gillingham, Kent, said: 'The work by SIGN is likely to be very useful and will form part of the [NICE] investigation.'

But Dr Minhas warned the 4mmol/l target would increase workload and prescribing costs. 'Guidelines have a duty to identify the resources needed to implement them if they are to have any significance for GPs in the real world.'

Dr John Pittard, CHD lead at North Surrey PCT and a GP in Staines, Middlesex, said: 'If 4mmol/l gets into the GP contract ­ and I suspect it will ­ the threshold needs to be set at a realistic level and should drop back to 50 per cent.'

dcressey@cmpi.biz

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