1 / 25

QRISK: a new CVD risk score development & validation Julia Hippisley-Cox Calgary 23 Oct 2007

QRISK: a new CVD risk score development & validation Julia Hippisley-Cox Calgary 23 Oct 2007. Acknowledgments coauthors. Carol Coupland statistician Yana Vinogradova statistician John Robson GP Margaret May statistician Peter Brindle GP. Acknowledgments. EMIS practices

jbenner
Download Presentation

QRISK: a new CVD risk score development & validation Julia Hippisley-Cox Calgary 23 Oct 2007

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. QRISK: a new CVD risk score development & validationJulia Hippisley-CoxCalgary23 Oct 2007

  2. Acknowledgmentscoauthors • Carol Coupland statistician • Yana Vinogradova statistician • John Robson GP • Margaret May statistician • Peter Brindle GP

  3. Acknowledgments • EMIS practices • David Stables & Andy Whitam (EMIS) • Dept Health

  4. Goals of presentation • Background to CVD risk prediction • Overview of development of QRISK (new score) • Key results & validation • Web calculator

  5. What is Framingham? • Framingham small town near Boston • Half the size of Mansfield • Recruited a cohort of 5,000 people in 1950 • Followed them for > 50 years • It has been hugely important

  6. Framingham Highlights • 1959 – described the ‘silent MI’ • 1960 – smoking, high BP & high chol bad • 1967 – exercise good • 1976 – menopause bad (for the heart!) • 1978 – psychological factors can be bad • 1988 – high HDL good • 1991 – risk prediction equation used ALL AROUND THE WORLD

  7. Why a new CVD risk score? • Small cohort 50 years ago from one American town • Almost entirely white • Developed during peak incidence CVD in US • Overpredicts CVD risk by up to 50% • Doesn’t include BMI, family history, blood pressure Rx, deprivation • But crucially it under estimates risk in patients from deprived areas

  8. Policy context • NICE publication of lipid modification guidelines July 2007 • Statins recommended if CVD risk > 20% • Need to population screening tool to identify high risk patients • Dept Health considering ‘life check’ • Potential utility of routinely collected data • Interested in self assessment • Concern about health inequalities

  9. Inverse equity hypothesis • This shows that when new interventions are introduced • Inequalities initially worsen (uptake quickest in the healthy and wealthy) • Eventually there is a ‘catch up’ but only when the wealthy reach a ‘ceiling’ • Need to be proactive to avoid new policies exacerbating health inequalities

  10. AIM for QRISK • New CVD risk score • Calibrated to UK population • Better discrimination • Use routinely collected GP data • Include additional known risk factors (eg FH, deprivation, BMI, BPRx)

  11. QRISK – general approach • QRISK is a new approach designed • to tailor management to the individual patient • to identify patients at high risk of disease • to identify those most likely to benefit or be harmed by treatment • Present risks and benefits back to patients at the point of care in an accessible way

  12. QRESEARCH database • the largest GP database worldwide • 525 practices, 10 million patients ever • Good historical data > 12 years • Numerous validation studies

  13. QRISK study cohort • Derivation cohort (2/3rds practices) & validation cohort (1/3rd) • All patients registered 1995-2007 • Men and women aged 35-74 • UK sample free from CVD & diabetes • Ethnically & socially diverse • 66,000 Cardiovascular disease events • 8.3 million person years

  14. Cardiovascular disease outcomes • Computer recorded clinical diagnosis of • Coronary heart disease • TIA or Stroke • Outcome similar to that in JBS2 • Validation against ONS certified cause of death 94% ascertainment

  15. QRISK risk factors • Traditional risk factors • Age, Sex, Smoking status • Systolic blood pressure • TSC/HDL ratio • (LVH – recorded prevalence too low) • New risk factors • Deprivation (townsend score output area) • Family history premature CVD 1st degree relative < 60 years • Body mass index • BP treatment

  16. Validation • Comparison against Framingham • Independent one third of the database • Various statistics • Predicted vs observed CVD events • Clinical effect in terms of reclassification of patients into high/low risk

  17. Validation statistics(note: higher scores are better)

  18. Degree of over prediction

  19. % of the UK population 35-74 years at high risk >20%

  20. Clinically important issue is degree of reclassification • If we use QRISK rather than Framingham • Overall one in 10 reclassified • QRISK identifies different group of patients who are at higher risk • Incorrect classification affects patients from deprived areas (ie more high risk patients missed)

  21. Strengths of QRISK • Better calibrated for UK than Framingham • Less likely than Framingham to over predict risk • Better at identifying patients likely to clinically benefit from treatment • Includes deprivation which makes it fairer • Can be implemented into GP computer systems • Can be periodically updated and refined

  22. QRISK: Web calculator • Designed for patients to use • Also needs integration into clinical system • Link http://www.qrisk.org • Username qrisk • Password beta test

More Related