Quality standard

Quality statement 1: Full formal risk assessment using QRISK3

Quality statement 1: Full formal risk assessment using QRISK3

Quality statement

Adults aged between 25 and 84 years with an estimated increased risk of cardiovascular disease (CVD) are offered a full formal risk assessment using the QRISK3 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. QRISK3 is the recommended formal risk assessment tool to assess CVD risk for the primary prevention of CVD in people aged between 25 and 84 years. QRISK3 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.

Clinical judgement should inform interpretation of results from CVD risk tools when used in certain groups of people because tools may underestimate the risk (see NICE's guideline on cardiovascular disease, recommendation 1.1.10).

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that the QRISK3 tool is used to formally risk assess adults between 25 and 84 years when an estimated increased risk of CVD is identified.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local protocols.

Process

Proportion of adults between 25 and 84 years with an estimated increased risk of CVD who have a full formal risk assessment using the QRISK3 tool.

Numerator – the number in the denominator having a full formal risk assessment using the QRISK3 tool.

Denominator – the number of adults between 25 and 84 years with an estimated increased risk of CVD.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (primary care services) ensure that systems are in place to offer adults between 25 and 84 years with an estimated increased risk of CVD a full formal risk assessment using the QRISK3 tool.

Healthcare professionals (such as GPs and nurses) ensure that they offer a full formal risk assessment using the QRISK3 tool to adults between 25 and 84 years with an estimated increased risk of CVD.

Commissioners ensure that they commission services that offer a full formal risk assessment using the QRISK3 tool to adults between 25 and 84 years with an estimated increased risk of CVD.

Adults between 25 and 84 years who may be at risk of developing CVD are offered a risk assessment. The GP or nurse uses a computer program called QRISK3 to fully assess their risk of developing CVD over the next 10 years. This takes into account factors including 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.

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. [NICE's guideline on cardiovascular disease, 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. [NICE's guideline on cardiovascular disease, recommendations 1.1.9 and 1.1.11]

Full formal risk assessment

This assessment should use the QRISK3 tool to calculate the estimated 10‑year CVD risk for the primary prevention of CVD in people aged between 25 and 84 years. Clinical judgement should inform interpretation of results from CVD risk tools when used in certain groups of people because tools may underestimate the risk (see NICE's guideline on cardiovascular disease, recommendation 1.1.10). [NICE's guideline on cardiovascular disease, recommendations 1.1.7 and 1.1.10].

Equality and diversity considerations

The statement includes adults aged between 25 and 84 years because this is the population in which the QRISK3 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. People aged under 25 are not at high risk for CVD unless they have a specific condition that increases risk.

Clinical judgement should inform interpretation of results from CVD risk tools when used in certain groups of people because tools may underestimate the risk (see NICE's guideline on cardiovascular disease, recommendation 1.1.10). When using a QRISK3 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.