Published 1 September 2009, doi:10.1136/bmj.b3485
Cite this as: BMJ 2009;339:b3485

Letters

QRISK validation and evaluation

QRISK may be less useful

The first 150 words of the full text of this article appear below.

Collins and Altman inappropriately criticise the National Institute for Health and Clinical Excellence (NICE) for not choosing QRISK to predict cardiovascular risk.¹ In doing so, they do not distinguish between assessing individual cardiovascular risk (as used by clinicians) and predicting risk of cardiovascular events in an actively managed population (as used in public health planning). As most tools predicting cardiovascular risk were developed in actively managed populations, they will underestimate the risk that clinicians and patients are initially interested in: the risk if no further treatment is initiated. This distinction seems to be overlooked in most discussion of cardiovascular risk.

Most doctors would expect to explain the risk to patients were they left untreated. As with several other tools, however, QRISK was derived from a population cohort that may start additional treatments once found to have high rates of risk factors. Hence it is not surprising that it underpredicts cardiovascular . . . [Full text of this article]

¹ Centre for Evidence-Based Medicine, Department of Primary Health Care, University of Oxford OX3 7LF

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Authors’ reply

Gary S Collins and Douglas G Altman
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This article has been cited by other articles:

• Collins, G. S, Altman, D. G (2009). Authors' reply. BMJ 339: b3516-b3516 [Full text]  

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