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QRISK

Status

Completed

Title

A new risk score to predict risk of developing cardiovascular disease for the UK

What were the objectives of the study?

To develop and validate updated prediction algorithms to estimate the risk of cardiovascular disease in women and men accounting for new and established cardiovascular risk factors.

QRISK is continually updated as
(a) population characteristics evolve over time
(b) new and improved data become available
(c) statistical methods improve and
(d) new risk factors are identified.

How was the research done?

Prospective open cohort study using routinely collected data from QResearch® general practices in England. 75% of QResearch GP practices are used to develop the scores and a separate set of 25% QResearch practices to validate the scores. Separate validation cohorts such as CPRD are also used for validation.

Patients are free of cardiovascular disease and not prescribed statins at baseline. Cox proportional hazards models and cause specific hazard models in the derivation cohort are used to derive separate risk equations in men and women. These equations predict both 1-10 year risk of cardiovascular disease and lifetime risk of cardiovascular disease. The equations are regularly updated to take account of changes in population risks over time, availability of new data, improvement in statistical methods and changes in requirements for how the tools can be used in clinical practice.

Measures of calibration, discrimination and reclassification are determined in the validation cohort for men and women separately and for individual subgroups e.g. age group, ethnicity. External validation is conducted in separate databases such as CPRD and THIN by the authors and also by external researchers.

Chief Investigator

Julia Hippisley-Cox

Lead Applicant Organisation Name

Sponsor

Oxford University

Location of research

Oxford

Date on which research approved

01-Feb-2019

Project reference ID

OX330

Generic ethics approval reference

18/EM/0400

Are all data accessed are in anonymised form?

Yes

Brief summary of the dataset to be released (including any sensitive data)

GP data for risk factors for cardiovascular disease linked to outcomes for CVD recorded on either GP, hospital or mortality data.

What were the main findings?

The first algorithm developed in 2007 was the QRISK tool, designed to estimate cardiovascular risk over 10 years. In 2010 a new version to predict lifetime risk of cardiovascular disease was developed to take account of the competing risk of death. Prior to QRISK, an algorithm developed in the US based on a small unrepresentative cohort was used to assess cardiovascular risk in the UK and target high risk individuals for treatment.

The QRISK model has been updated to account for time trends, improvements in data quality, new data linkages and to include additional risk factors. The QRISK3 algorithm (www.qrisk.org/three/) was the first cardiovascular risk algorithm to include major risk factors such as serious mental illness, atypical antipsychotics, migraine, corticosteroids and blood pressure variability.

Implications and Impact

QRISK forms the basis of the NHS Health check for all adults aged 40-74 years. It is also included in the GP Quality and Outcomes framework for assessment of cardiovascular disease (CVD) risk in people with diabetes and rheumatoid arthritis and multiple NICE guidance and quality standards. It is recommended in the updated NICE guidance [NG136, 2019] on hypertension in adults which includes the use of QRISK to inform antihypertensive treatment. The NHS Health checks program has published guidance on moving from QRISK2 to QRISK3.

QRISK has been widely validated with consistently excellent results. QRISK1 and QRISK2 showed improved performance compared with Framingham on external datasets.

Similarly, in 2021 QRISK3 was independently and externally validated on CPRD with very good overall performance. It has been validated in 2021 in subgroups of patients with specific conditions including learning disabilities and inflammatory bowel disease with very good performance.

In 2020 QRISK3 was compared with SCORE among people with systemic lupus erythematosus and in 2022 it was validated against Framingham among people with systemic sclerosis.

In 2023, QRISK3 was recommended for use by the National Institute for Clinical Excellence.

Public Benefit Statement

Research Team

Julia Hippisley-Cox, Carol Coupland, Peter Brindle, Keith Shannon, Aziz Sheikh, Mona Bafadhel, Richard Russell

Publications

Press Releases

Access Type

Trusted Research Environment (TRE)

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