Single cardiovascular risk tool needed for UK

NICE guidelines on lipid modification prompt experts to call for consistency in cardiovascular risk tools.

A single cardiovascular risk assessment tool is needed for the whole of the UK, experts have warned.

The call comes after NICE reversed its decision to recommend the use of QRISK in England and Wales in favour of the Framingham 10-year risk equations. Meanwhile GPs in Scotland look set to adopt their own risk tool called ASSIGN.

NICE guidance on lipid modification was released this week after being delayed for months so that the watchdog could consider the value of QRISK.

Draft NICE guidance from February favoured QRISK over Framingham. But NICE has U-turned and decided to stick with Framingham.

But NICE appears to be unclear on the value of Framingham, stating that 'there is an urgent need to establish which score is most acceptable for use in England and Wales'.

The ASSIGN risk tool has been developed to take into ac-count factors suited to Scotland such as deprivation levels.

A spokeswoman for the Scottish government said: 'ASSIGN has been piloted in practices in south-west Glasgow. It will be rolled out across Scotland and be made available for all practices as a web-based tool.'

However, North Yorkshire GP Dr Terry McCormack, chairman of the Primary Care Cardiovascular Society, warned against countries adopting their own risk tools.

'All the calculators are inac-curate to some degree and which one you use is not as important as having a consistent approach,' he said.

QRISK should be developed further and when it is fully validated, it will be adopted, Dr McCormack added.

Dorset GP Dr Graham Archard, who has an interest in cardiovascular disease, said that as long as NICE and its Scottish equivelant SIGN had different criteria, getting a single risk tool would be tricky.

'At the moment the body of evidence is probably with Framingham but this needs to be reviewed when new evidence comes to light,' he said.

Elsewhere, NICE has issued updated guidance on the management of type-2 diabetes, which focuses on patient- centred care.

Newly diagnosed patients should be offered glucose self-monitoring kits it says, despite recent studies suggesting that self-monitoring has no benefit for blood glucose control or the risk of hypoglycaemia.

sanjay.tanday@haymarket.com

NICE Lipid modification guidance 2008

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