Cardiovascular Disease Risk Assessment Using QRISK

Authored by: Dr Matthew Lee; BMSc, MBBS, MSc

What’s In This PocDoc Article?

• Using QRISK in the Fight Against Cardiovascular Disease
• What is QRISK?
• How Accurate is QRISK?
• QRISK and Primary Prevention
• Factors considered in the QRISK Algorithm
• What does the QRISK Algorithm tell us?
• How QRISK is used in Clinical Practice
• Limitations of QRISK
• Frequently Asked Questions

Using QRISK in the Fight Against Cardiovascular Disease

Cardiovascular disease (CVD) is a global health concern and the leading cause of death globally. Identifying people at risk of CVD before they have a first heart attack or stroke is important because it enables early intervention in the form of lifestyle changes and medication. Early intervention promises to reverse the burden of CVD. Various tools have been developed to help healthcare providers identify people at risk of developing CVD. In the UK, the QRISK tool is used; the most recent iteration is QRISK3. PocDoc integrates this algorithm into its CVD risk assessment tool. Together with PocDoc’s lipid marker test , this enables easy, rapid, digital determination of a person’s CVD risk.

What is QRISK?

QRISK is a risk assessment tool used within primary care to calculate an individual's risk of having a CVD event (heart attack or stroke) over the next 10 years. The tool incorporates a wide range of factors, including but not limited to:

• Age
• Sex
• Body mass index (BMI)
• Ethnicity
• Blood pressure
• Cholesterol levels

How Accurate is QRISK?

This QRISK Algorithm has been validated by the Centre for Statistics in Medicine (University of Oxford), and the results published in the BMJ. The results showed that the QRISK algorithm performed better than the previously used CVD risk tool (Framingham Risk Score). Based on this evidence, the UK’s National Institute for Health and Care Excellence (NICE) recommends using QRISK.

QRISK and Primary Prevention

Primary Prevention

The QRISK tool is very useful in the primary prevention of CVD. Primary prevention of CVD is the intervention through lifestyle changes or medications in patients who have not yet had a heart attack or stroke. 

Secondary Prevention

QRISK is not used for secondary prevention, which is prevention in patients who have already had a CVD event such as a heart attack or stroke. Different tools are used to assess further risk in these patients.

Factors Considered in the QRISK Algorithm

The QRISK3 algorithm is a comprehensive analysis of risk and includes a variety of patient-specific information as inputs:

• Demographic information: Age, sex, ethnicity, postcode (used to calculate the Townsend deprivation score)

• Clinical values: Systolic blood pressure, body mass index (BMI), Total cholesterol: HDL ratio ( TC to HDL ratio )

• Medical history: Existing conditions like diabetes, rheumatoid arthritis, chronic kidney disease, atrial fibrillation

• Lifestyle factors: Smoking status, whether the patient is on blood pressure treatment

• Family history: Family medical events like coronary heart disease in a first-degree relative under the age of 60

What does the QRISK Algorithm tell us? 

The QRISK tool calculates your risk of having a cardiovascular event, like a heart attack or stroke, over the next 10 years. This 10-year risk assessment is important as it provides real information on your cardiovascular health informing that you may want to make lifestyle changes or take medications to reduce your risk.

Calculating this 10-year risk, the QRISK tool offers two key insights:

1. Comparison with Population Average: The calculated risk compares your risk with other people of the same age, sex, ethnicity and background. This helps you see if you're doing better, worse, or average compared to others.

2. Healthy Heart Age: Your Healthy Heart Age refers to the age at which someone, of your same sex and ethnicity but without any additional risk factors, would have your specific 10-year QRISK score.

For example:

• If your Healthy Heart Age is greater than your actual age, it signifies that risk factors, such as lifestyle or genetics, have aged your heart faster than the typical rate

• If it's lower, it suggests that you have a healthier heart than the average for your age group

How QRISK is Used in Clinical Practice

In clinical practice, healthcare providers input patient information into the QRISK calculator, which calculates the individual's estimated risk of developing a cardiovascular event over the next ten years.

For individuals identified as being at high risk (currently defined in the NHS as a QRISK score of 10% or more), healthcare providers can take proactive steps to mitigate this risk. This might involve lifestyle changes, medications to control blood pressure or cholesterol levels, and frequent monitoring of the individual's health, including more frequent lipid checks.

The score acts as a discussion point between individuals and healthcare providers, helping to raise awareness about CVD and encouraging people to adopt proactive prevention strategies.

PocDoc: CVD Risk Assessment at Your Fingertips

Incorporating the QRISK algorithm alongside PocDoc’s lipid marker test in the PocDoc platform provides a comprehensive CVD risk assessment. PocDoc’s lipid marker test is a 5-marker lipid panel in lateral flow format that uses a mobile device such as a phone or tablet as the diagnostic reader. As elevated levels of some lipids can increase the risk of CVD adding a rapid lipid test at the time of the cardiovascular risk assessment adds valuable information.

Limitations of QRISK:

It’s important to recognise that any CVD risk tool may underestimate risk in certain groups of people, including:

• People already taking medicines to treat CVD risk factors

• People treated for HIV

• People who have recently stopped smoking

• People taking medicines that can cause dyslipidaemia such as immunosuppressant drugs

• People with severe mental illness

• People with autoimmune disorders, and other systemic inflammatory disorders

Download PocDoc's QRISK Booklet PDF Here

FAQs About QRISK and Cardiovascular Disease Risk Assessment

1. What is QRISK?

• The QRISK3 algorithm, the most recent iteration of QRISK, is a risk assessment tool used to calculate an individual's risk of having a heart attack or stroke over the next 10 years. These are both cardiovascular disease (CVD) events
  

• It incorporates a variety of factors including age, sex, BMI, ethnicity, blood pressure, and cholesterol levels among others

2. How accurate is QRISK?

• QRISK has been validated by the Centre for Statistics in Medicine (University of Oxford)

• Studies published in the BMJ show that it performs better than the previous CVD risk tool, the Framingham Risk Score

• Based on this evidence the National Institute for Health and Care Excellence (NICE) in the UK recommends using QRISK3

3. How does QRISK assess risk?

• QRISK calculates the chance of having a CVD event in the next 10 years

• This provides insight to guide immediate interventions and to encourage long-term healthy habits

4. How is QRISK used in conjunction with PocDoc's lipid marker test?

• The PocDoc CVD risk assessment tool integrates the QRISK algorithm alongside PocDoc’s lipid marker test

• PocDoc’s lipid marker test is a 5-marker lipid panel in lateral flow format that uses a mobile device such as a phone or tablet as the diagnostic reader

5. What actions are taken if an individual is identified as high risk?

• For individuals identified as high risk (currently defined by the NHS as a QRISK score of 10% or more), healthcare providers will strongly recommend steps to reduce the individual’s risk

• This can involve lifestyle changes, medications to control blood pressure or cholesterol levels, and regular monitoring of the individual's health

6. What are the limitations of QRISK?

QRISK should only be used in individuals without a history of heart attacks or stroke (e.g. it is only for use in primary prevention).

QRISK may underestimate risk in certain groups of people, including:

• People already taking medicines to treat CVD risk factors
• People treated for HIV
• People who have recently stopped smoking
• People taking medicines that can cause dyslipidaemia such as immunosuppressant drugs
• People with  severe mental illness
• People with autoimmune disorders, and other systemic inflammatory disorders

Download PocDoc's QRISK Booklet PDF Here