Quality statement 1: Full formal risk assessment using QRISK2

Quality statement

Adults under 85 years with an estimated increased risk of cardiovascular disease (CVD) are offered a full formal risk assessment using the QRISK2 tool.

Rationale

A full formal risk assessment for adults who have been identified to have an estimated increased risk of CVD is the most accurate method of targeting prevention strategies to improve clinical outcomes. QRISK2 is the recommended formal risk assessment tool to assess CVD risk for the primary prevention of CVD in people up to and including the age of 84 years. QRISK2 is an online assessment tool for estimating the 10‑year risk of having a cardiovascular event, in people who do not already have heart disease. A person's 10‑year risk of CVD can be used to inform treatment decisions, such as lifestyle advice or drug treatment.

Adults aged 85 years and over and those with existing CVD, type 1 diabetes, chronic kidney disease or familial hypercholesterolaemia should be considered to be at an increased risk of CVD events without using QRISK2. For these people, a full formal assessment with QRISK2 does not provide any additional information and could underestimate their risk of CVD, leading to inappropriate treatment.

Quality measures

Structure

Evidence of local arrangements to ensure that the QRISK2 tool is used to formally risk assess adults under 85 years when an estimated increased risk of CVD is identified.

Data source: Local data collection.

Process

Proportion of adults under 85 years with an estimated increased risk of CVD who have a full formal risk assessment using the QRISK2 tool.

Numerator – the number in the denominator having a full formal risk assessment using the QRISK2 tool.

Denominator – the number of adults under 85 years with an estimated increased risk of CVD.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (primary care) ensure that systems are in place to offer adults under 85 years with an estimated increased risk of CVD a full formal risk assessment using the QRISK2 tool.

Healthcare professionals ensure that they offer a full formal risk assessment using the QRISK2 tool to adults under 85 years with an estimated increased risk of CVD.

Commissioners (NHS England area teams) ensure that they commission services that offer a full formal risk assessment using the QRISK2 tool to adults under 85 years with an estimated increased risk of CVD.

What the quality statement means for patients, service users and carers

Adults under 85 years who may be at risk of developing CVD are offered a risk assessment. The GP or nurse uses a computer program called QRISK2 to fully assess their risk of developing CVD over the next 10 years. This takes into account the person's age, sex, smoking status, blood pressure and cholesterol levels, all of which can affect the risk of developing CVD. It will help identify adults who need lifestyle advice and possibly treatment to reduce their risk.

Source guidance

Definitions of terms used in this quality statement

Estimated increased risk of CVD

To estimate risk of CVD, use CVD risk factors that are already recorded in primary care electronic medical records using a systematic strategy. [Lipid modification (NICE guideline CG181) recommendations 1.1.1 and 1.1.2]

Adults aged 85 years and over, and those with pre‑existing CVD or other clinical conditions that increase CVD risk (such as type 1 diabetes, familial hypercholesterolaemia or chronic kidney disease) are already considered at high risk and so should be excluded from estimations of increased risk and formal risk assessment. [Lipid modification (NICE guideline CG181) recommendations 1.1.9, 1.1.11, 1.1.15, 1.1.16, 1.1.21]

Full formal risk assessment

This assessment should use the online QRISK2 tool to assess the 10‑year CVD risk for the primary prevention of CVD in people aged up to and including 84 years.

Equality and diversity considerations

The statement includes adults aged under 85 years because this is the population in which the QRISK2 tool is valid. Adults aged 85 years and older should be considered to be at high risk based on age alone, particularly those who smoke or have high blood pressure. Because QRISK2 calculates a person's risk of CVD over the next 10 years, its risk scores may underestimate risk in younger people or women who have additional risk because of underlying medical conditions such as serious mental health problems or severe obesity (body mass index greater than 40 kg/m2). When using a QRISK2 risk score to inform treatment decisions in these populations, particularly if it is near the threshold for treatment, take into account other factors that may predispose the person to premature CVD that may not be included in calculated risk scores.