QOF checks for elderly 'pointless'

Incentives to check blood pressure and cholesterol in older patients should be cut from the quality framework because the tests do not predict risk of death from heart disease, Dutch researchers say.

Dr Wouter de Ruijter, GP researcher at Leiden University Medical Center, criticised routine measurement of BP or cholesterol levels to estimate risk of cardiovascular death. He said such checks were not evidence-based for primary prevention in people over 85 years old, and possibly for slightly younger people.

'In our view such actions should therefore not be quality indicators; this would be a wrong incentive for GPs,' he said. Other measures, such as homocysteine, could replace them, he suggested.

Dr de Ruijter and colleagues reported that homocysteine levels predict cardiovascular risk in older people better than other measures.

Classic risk factors, such as those included in the Framingham risk score, did not accurately predict cardiovascular mortality, they said. However, using homocysteine levels led to a 23 per cent increase in people correctly classified as high-risk.

Richard Hobbs, professor of primary care at Birmingham University and a member of the Primary Care Cardiovascular Society, said that QOF indicators on risk markers are based on unequivocal and well-established evidence.

'Modifying established risk factors can reduce the risk of major events such as stroke, and that remains an association between levels of those risk factors and the frequency of events,' he told GP.

'The potential value of emerging risk markers remains of interest but it is premature to consider their inclusion in quality indicators.'


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