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Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study

BMJ 2017; 357 doi: (Published 23 May 2017) Cite this as: BMJ 2017;357:j2099

Rapid Response:

Re: Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study.

We welcome the publication of the QRisk3 score which includes variables for both severe mental illness (SMI) and antipsychotics. We have published a range of work regarding SMI and cardiovascular disease, including research showing that existing cardiovascular risk scores may perform less well for people with SMI (1). This is important since people with SMI continue to suffer elevated rates of CVD compared to the general population.

Qrisk3 defines SMI similarly to our own work and similarly to NICE, to include schizophrenia, bipolar disorder and other psychoses. However we are interested in the high prevalence of SMI in the QRisk3 cohort which is 4.3% for men and 6.8% for women.  This is far higher than the usual community rates of SMI, the SMI rates in other UK primary care database studies or rates that are quoted in NICE indicators (namely 0.5-2%) (1-3)
Conversely, the levels of second generation antipsychotic  prescribing in the QRisk3 cohort (0.5%) are more in keeping with published SMI rates, although it is of note that around half UK antipsychotics are prescribed to people without  SMI diagnoses (4).
It would be helpful if the authors clarified the diagnoses included within their SMI category, so that the correct conditions can be included when applying and assessing the new QRisk3 score.

Prof David Osborn
Dr Kate Walters

1. Osborn, D. P., Hardoon, S., Omar, R. Z., Holt, R. I., King, M., Larsen, J., . . . Petersen, I. (2015). Cardiovascular risk prediction models for people with severe mental illness: results from the prediction and management of cardiovascular risk in people with severe mental illnesses (PRIMROSE) research program. JAMA Psychiatry, 72 (2), 143-151. doi:10.1001/jamapsychiatry.2014.2133

2. Hardoon, S., Hayes, J. F., Blackburn, R., Petersen, I., Walters, K., Nazareth, I., & Osborn, D. P. J. (2013). Recording of Severe Mental Illness in United Kingdom Primary Care, 2000-2010. PLoS One.

3. National Institute for Clinical Excellence. Standards and Indicators. NM120. (2015) (accessed May 24th 2017).

4. Marston, L., Nazareth, I., Petersen, I., Walters, K., & Osborn, D. P. (2014). Prescribing of antipsychotics in UK primary care: a cohort study. BMJ Open, 4 (12), e006135-?. doi:10.1136/bmjopen-2014-006135

Competing interests: DO and KW have received grant funding from the NIHR and MRC related to the assessment and management of cxardiovascular risk in people with SMI

25 May 2017
David P Osborn
Professor of Psychiatric Epidemiology
Dr Kate Walters, Reader in Primary Care and Epidemiology, UCL
Division of Psychiatry, UCL
Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF.