Intended for healthcare professionals

Rapid response to:

Education And Debate

Risk factor thresholds: their existence under scrutiny

BMJ 2002; 324 doi: (Published 29 June 2002) Cite this as: BMJ 2002;324:1570

Rapid Response:

Dynamic CHD risk profiling for focused recall

We have instigated a project, which gives dynamic updated full or
estimated risk scores to the whole of the eligible population in the PCG
(Blyth Valley, Northumberland).

One of the main clinical computer systems is used universally here
with the Framingham equation in-built. All in the eligible population (30-
74 without established cardiovascular disease) may have the scores
calculated automatically electronically by the system, then allocated
coded in to their computer records. The scores are updated routinely as
the parameters change. Where some of the seven parameters are missing an
Estimated risk score may be allocated. The system also corrects where the
wrong category of score has been entered. The risk profile for any sub-
population may then be, fairly instantly, presented and the names of
individuals in any band given. Those at highest Full or Estimated risk can
be recalled for intervention and groups at intermediate Estimated risk in
any target group (e.g. hypertensives or those with family history) picked
out by degree so that the Full score may be calculated by completing e.g.
the HDL or ECG.
This system, we feel, is the most precise way to focus resources to
attempt the NSF standard 4 about which the public health group form
Birmingham (1) were correct to be sceptical . It also allows a more
sophisticated way of deciding thresholds not only at absolute risk levels
but at optimum age-risk to maximise life-years gained-free-of-events (2).
Our scheme has involved a combination of IT development with governance
and training initiatives for clinicians and practice administration. It
has allowed a more convincing dialogue with patients and provided
reassurance that that some individuals need less monitoring than others.
We hope that from it an evidence base for more focused primary prevention
may come.

1-Rouse A. and Adab P. Is population coronary heart disease risk
screening justified? A discussion of the National Service Framework for
coronary heart disease. J R Coll Gen Pract 2001;51;834-837

2-Ulrich S. and Vallance P. What is the optimal age for starting lipid
lowering treatment? A mathematical model BMJ 2000;320:1134-1140

3-McManus et al. Comparison of estimates and calculations of risk of
coronary heart disease by doctors and nurses using different calculation
tools in general practice: cross sectional study BMJ 2002;324:459-464

Competing interests: No competing interests

11 July 2002
John M. Waddell
GP Principal Cramlington Northumberland BlythValley Clinical Governence Group
Paul Murphy, Darren Balsdon, David Brown
Health Centre Forum Way Cramlington Northumberland NE23 6QN