Research backs QRISK

The QRISK formula for identifying patients most at risk of developing cardiovascular disease should replace the Framingham risk score in the UK, researchers recommend today.

A study published in the BMJ compares the performance of the QRISK and Framingham scores for predicting 10-year cardiovascular disease risk in more than 1m UK patients.

It found that, on every performance measure, QRISK gave a more accurate prediction.

The National Institute for Health and Clinical Excellence recommends that doctors use a modified version of the Framingham score to identify who should be offered statin treatment to reduce their risk of heart disease.

The latest study follows a paper published in the BMJ in 2007 which also concluded that the QRISK score was a more accurate measure of how many UK adults are at risk of developing heart disease and which adults are most likely to benefit.

In 2008, NICE made draft recommendation that doctors should switch to using QRISK but later reversed its decision, recommending instead a modified version of Framingham.

The researchers from Oxford University tracked the progress of 1.07m patients registered at 274 GP practices in England and Wales for up to 12 years after first diagnosis of cardiovascular disease.

The researchers said QRISK performed better on every measure, It found that the rate of cardiovascular disease among men was 30.5 per 1,000 person years in high risk patients identified with QRISK and 23.7 per 1,000 years in high risk patients identified with Framingham.

The rate of cardiovascular disease events among women was 26.7 per 1,000 person years in high risk patients identified with QRISK compared with 22.2 per 1,000 person years in high risk patients identified with Framingham.

The researchers say their findings are not surprising as QRISK was developed on a large cohort of patients in the UK and contains additional risk factors such as social deprivation and family history, which are known to affect cardiovascular disease risk but are not included in the Framingham scores.

In an accompanying editorial, researchers from Auckland University also back use of QRISK but say it is just the first of many continuously updateable prediction algorithms that will become available as electronic health records replace paper based systems.

They argue that algorithms should be freely shared to facilitate their effective implementation.

The QRISK formula has been developed by Nottingham University in a not for profit partnership with healthcare systems supplier EMIS.

Professor Julia Hippisley-Cox from Nottingham University’s primary care division said QRISK had the potential to save many thousands of lives.

She added: “We are delighted to receive another strong endorsement of the value of QRISK in assessing the risk of heart disease in the UK population.”

EMIS said the QRISK2 formula can already be accessed by the 56% of GPs in the UK who use EMIS clinical records systems.

It said other clinical systems providers can access the new equation through a software development kit designed to ensure the safe and accurate use of the formula.