The number of people in the UK at risk from developing heart disease has been overestimated by as much as 1.5 million, according to the findings of a study published in the British Medical Journal online.
The study looked at 1.28 million patients, aged 35-74 years, who registered at 318 practices between January 1995 and April 2007 and were free of diabetes and existing cardiovascular disease. Researchers from the University of Nottingham, Bristol Primary Care Trust, and the Universities of Bristol and Queen Mary derived a new cardiovascular risk score - known as QRISK - that considers factors such as genetic makeup, treatment with antihypertensives, body mass index and social deprivation - to calculate each person’s risk of developing cardiovascular disease.
According to QRISK, 3.2 million people under the age of 75 living in the UK are at risk from heart disease, which is significantly lower than the previous estimate of around 4.7 million, calculated using the traditional, US-developed Framingham score, which doesn’t take into account the factors mentioned above although they are known to have a significant effect on risk.
The study’s findings follow recent guidance from the National Institute for Health and Clinical Excellence that recommends treating all patients in the UK with a 20% risk or more of developing cardiovascular disease with statins.
As the researchers point out, over-estimation of cardiovascular risk will lead to an excessive number of people being flagged for potentially life-long treatment on the National Health Service, which not only has a major impact on its teetering finances but also exposes patients to unnecessary medication and related side effects.
The researchers also stress the importance of taking social deprivation into account when assessing patients for preventative treatment with statins on the NHS “to reduce rather than exacerbate current social inequalities in cardiovascular disease and to target those at greatest risk.”
“We think that QRISK is likely to provide more appropriate estimates of cardiovascular disease risk in contemporary UK populations and better discriminate those at high risk on the basis of their age, sex, and social deprivation as well as existing antihypertensive treatment. It is likely therefore to be a more equitable tool to inform patient management decisions,” they conclude.
Commission reports on heart failure services
Publication of the study’s findings also coincides with a report by the Healthcare Commission into services provided to patients with heart failure which, although largely positive, expressed concern that a significant number of patients may not be being identified.
Pushing the Boundaries found that the number of patients reported as having heart failure was 140,000 fewer than expected. According to the Commission, this could be due to GPs experiencing problems while recording patient data, but it could also mean that some are not being properly diagnosed and, thereby, treated.
Commenting on the findings, Anna Walker, Chief Executive of the Healthcare Commission, said that the “report suggests that not all those that need treatment are getting it. Primary care trusts and GPs need to monitor the number of patients they deal with in comparison to national statistics [and] symptoms and treatments need to be recorded and followed up by GPs.”
The report is based on a review of heart failure services provided by 303 healthcare communities (the PCT and its main hospital providers); two-thirds of the communities scored ‘excellent’ (28) or ‘good’ (160), while a further 89 were classed ‘fair’. However, 26 were assessed as ‘weak’, although the HC has said it is already working with these communities to help them improve their performance.