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Heart tsar calls for QRISK to replace Framingham score



By Nigel Praities

Exclusive: The Government’s heart tsar has given the strongest endorsement yet for QRISK to be used instead of the Framingham cardiovascular risk score – saying it would be ‘perverse’ not to use the newer tool.

Professor Roger Boyle, national director for heart disease and stroke, has recommended GPs use QRISK to make cardiovascular risk assessments – because it factors in deprivation – but said the licensing cost had blocked the DH from mandating its use.

The introduction of the QRISK score has proved controversial; with cardiology experts slamming it’s inclusion in draft NICE guidelines in 2008.

It was later withdrawn from the guidance, but an updated version of the score has been backed by the DH for use alongside Framingham for the vascular risk assessment scheme in all those aged 40 to 74 years.

Professor Boyle said he estimated a number of PCTs were using QRISK2 for the NHS Health Check programme, but revealed his frustration the score had not been adopted more widely.

‘It seems to me rather perverse to use a risk engine that does not use deprivation when we know it is such a powerful determinant.

‘Because QRISK is developed on the QRESEARCH data – and is therefore embedded in EMIS – other providers have found it difficult to purchase the licence, so we can’t actually mandate it,’ he explained in a RCGP roundtable discussion on cardiovascular disease.

QRISK is currently only available for use under a licence from EMIS that costs £10,000, although a spokesperson from the company said that it was currently in talks with other system providers to supply QRISK to the majority of GPs.

‘It is or will soon be widely available to the vast majority of working GPs, as part of their existing clinical systems or as bolt ons,’ she said.

Dr Christopher Arden, a cardiology GPSI in Eastleigh, Hampshire, urged EMIS to quickly make QRISK ‘freely accessible’ so all providers of vascular checks could use it.

‘Framingham has done a good job, but it is outdated. We use QRISK, but I don’t think that the nurses running the walk-in assessments are using it. It is chaos really, and you want consistency,’ he said.

Professor Boyle also revealed the Department of Health would reveal a ‘minimum dataset’ in the next few weeks so that the progress of the vascular checks programme could be monitored.

‘We are still struggling with getting the right IT system so that wherever the check is done it is done, there is an efficient system of getting that back into the primary care record, so that across a PCT or cardiovascular network we can get a clearer picture of how the programme is developing and look at that data at a national level,’ he said.

Using Framingham instead of QRISK is ‘perverse’ says heart tsar RCGP debate on CVD