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QRISK ‘performs better than Framingham’ say independent experts

By Lilian Anekwe

An independent evaluation of two different tools to predict cardiovascular risk published today reveals the UK-based QRISK score is more accurate in a UK population, compared with Framingham.

The assessment by researchers at the University of Oxford - published today by the British Medical Journal - puts more pressure on NICE to reconsider its advice on CV risk prediction.

NICE shied away from recommending QRISK over Framingham over the other in March, saying only that both tools had ‘positive features', and instructing GPs to make their own decision about which tool to use for cardiovascular risk assessments.

Pulse also revealed in March that heart tsar Professor Roger Boyle strongly endorsed QRISK, saying it was ‘perverse' to use Framingham when it does not take deprivation into account.

The BMJ study found that in a cohort of UK patients drawn from general practice records, QRISK 2 offered improved prediction of a patient's 10-year risk of cardiovascular disease over the NICE version of the Framingham equation.

Researchers drew data from 1.6 million patients registered at 365 patients in the Health improvement Network and compared the 10-year estimated cardiovascular disease risk for every patient using the two different tools.

QRISK2 explained 33% of the variation in men and 40% for women, compared with 29% and 34% respectively for the NICE Framingham and 32% and 38% respectively for QRISK1.

The incidence rate of cardiovascular events (per 1000 person years) among men in the high risk group was 27.8 (95% CI 27.4 to 28.2) with QRISK2, 21.9 (21.6 to 22.2) with NICE Framingham, and 24.8 (22.8 to 26.9) with QRISK1.

Similarly, the incidence rate of cardiovascular events (per 1000 person years) among women in the high risk group was 24.3 (23.8 to 24.9) with QRISK2, 20.6 (20.1 to 21.0) with NICE Framingham, and 21.8 (18.9 to 24.6) with QRISK1.

Dr Gary Collins, senior medical statistician at the University of Oxford, concluded: ‘In this large cohort of 1.6 million patients, the NICE Framingham equation had inferior performance compared with either QRISK2 or its predecessor, QRISK1.

‘The NICE Framingham risk score over-predicted 10-year risk of cardiovascular disease, compared with the more accurate QRISK2 and QRISK1 scores.'

QRISK is better than Framingham