England and Wales may use QRISK tool

NICE is thinking of recommending a cardiovascular risk tool developed in UK primary care for use across England and Wales.

It has put back publication of the lipid modification advice, due out in January, so that the guideline development group can consider the value of QRISK.

Developed from the EMIS records of 529 GP practices, QRISK incorporates a logorithm of age, ratio of serum total to HDL cholesterol, systolic BP, BMI, family history of premature cardiovascular disease (CVD), smoking status, Townsend deprivation score and use of one or more BP treatments.

If recommended, QRISK could drive down use of statins by more than a third. Patients with a 20 per cent risk of having a cardiovascular risk over 10 years are recommended to be put on statins
But current cardiovascular risk tools, including Framingham and ASSIGN, are thought to overestimate the number of patients at risk of CVD by 35 per cent.

In a statement on its website, NICE said there are ‘some commonly acknowledged problems applying the Framingham equations in England and Wales in particular because they tend to overestimate risk in most of our population but underestimate risk in some groups’.

The decision to review QRISK as an alternative follows publication of a second analysis of QRISK, showing the tool worked in an independent evaluation of more than a million UK patients.

The new date for publication of the lipid modification clinical guideline is still to be confirmed.


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