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Home > Professional Reference > QRISK®2 Cardiovascular Risk Score

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QRISK®2 Cardiovascular Risk Score

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

Description

This is an innovative new cardiovascular disease risk calculator, based on the QRESEARCH® database of anonymised UK primary care patients. In 2003 the database was established jointly by the University of Nottingham and the EMIS GP computing company, and now contains over 10 million patients (over 550 practices) spread throughout the UK, with encrypted records being updated daily.1

Using this data, a cohort of 1.28 million patients without evidence of diabetes mellitus (DM) or cardiovascular disease (CVD) was identified, and followed up for >5 years, looking for the first development of CVD as an endpoint.2

The current version of the calculator (QRISK®2) uses the following parameters (if known - missing values are calculated by a complex averaging procedure called multiple imputation):3,4

  • Patient age (35-74).
  • Patient gender.
  • Current smoker (yes/no).
  • Diabetic.
  • Family history of heart disease aged <60 (yes/no).
  • Existing treatment with blood pressure agent (yes/no).
  • Postcode (postcode-related Townsend score) - an area measure of deprivation.
  • Body mass index (height and weight).
  • Systolic blood pressure (use current not pre-treatment value).
  • Total and HDL cholesterol.
  • Self-assigned ethnicity.
  • Rheumatoid arthritis.
  • Chronic kidney disease.
  • Atrial fibrillation.

The calculator is available at http://www.qrisk.org/

Note: the calculator uses ethnicity (should not be confused with nationality)! Read code 38DP can be used to record risk in a medical record.

Discussion

Comparing with the existing Joint British Societies' Cardiovascular Risk Calculation (which is based on Framingham data):5

Advantages

  • Calculated risk is calibrated to the contemporary UK population, so is likely to provide more appropriate risk estimates to help identify high-risk patients.
  • Calculated risk is adjusted for additional variables - social deprivation and current treatment with antihypertensives.
  • It has been validated in the UK using an alternative research database.6

QRISK®2 identifies a different high-risk group of patients than the Framingham equation, with one in ten patients being reclassified into high-risk or low-risk.

Disadvantages

  • Although the calculator uses a complicated algorithm to estimate missing variables, cholesterol risk behaves more as expected if full values are used.
  • It still cannot be used legitimately for 'what if' scenarios.

National Institute for Health and Clinical Excellence (NICE) 20105 no longer recommends the Framingham risk equation as the equation of choice for assessment of CVD risk, and allows users to use different risk assessment calculators such as Qrisk®2 if the user believes them to be more appropriate.

Other coronary heart disease/cardiovascular disease primary risk calculators

There is also a specific ETHRISK® calculator based on Framingham data which may be appropriate for British black and ethnic minority groups.7

Document references

  1. QResearch® Database, University of Nottingham
  2. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007 Jul 21;335(7611):136. Epub 2007 Jul 5.
  3. QRISK® Cardiovascular Risk Assessment Calculator
  4. Hippisley-Cox J, Coupland C, Vinogradova Y, et al; Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ. 2008 Jun 28;336(7659):1475-82. Epub 2008 Jun 23. [abstract]
  5. Lipid modification, NICE Clinical Guideline (May 2008); (Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease.) amended May 2010
  6. Hippisley-Cox J, Coupland C, Vinogradova Y, et al; Performance of the QRISK cardiovascular risk prediction algorithm in an independent UK sample of patients from general practice: a validation study. Heart. 2008 Jan;94(1):34-9. Epub 2007 Oct 4. [abstract]
  7. ETHRISK® - Ethnic Group CHD Risk Calculator (modified Framingham); A modified Framingham CHD and CVD risk calculator for British black and minority ethnic groups
© EMIS 2011Author: Dr Huw ThomasReviewer: Dr Gurvinder Rull
Document ID: 8701Document Version: 8Last Reviewed: 13 Jan 2011
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