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New heart disease calculator could save lives by identifying high-risk patients missed by current tools

New research spearheaded by The University of Oxford has helped develop a new tool called QR4 that improves the accuracy of predicting an individual's 10-year risk of cardiovascular diseases. Published earlier this month in Nature Medicine, the research has shown the tool’s capabilities to be particularly improved in identifying high-risk patients that current prediction tools miss.

QR4 functions as a calculator utilising an individual’s health data, such as blood pressure, age and medical history, to estimate their likelihood of developing a cardiovascular disease over the next 10 years, allowing doctors to intervene early and prevent illness.

QR4 includes seven new risk factors applicable to all adults: chronic obstructive pulmonary disease (COPD), learning disabilities, Down syndrome and four cancer types (blood, lung, oral and brain), highlighting how other significant diseases impact on heart health. Equally, it also identifies factors specific to women's health that were predictive of future heart disease risk, such as complications from high blood pressure during pregnancy, and postnatal depression.

“While traditional cardiovascular risk factors such as smoking and high cholesterol are well-recognised, our latest research identifies less obvious, yet crucial risk indicators,” says Professor Julia Hippisley-Cox, lead author, Professor of Clinical Epidemiology and General Practice, at the University of Oxford’s Nuffield Department of Primary Care Health Sciences.

“For instance, conditions like postnatal depression and Down’s syndrome significantly contribute to cardiovascular risk, underscoring the complex interplay between mental health, genetic factors, and heart health. QR4 also helps to address inequalities in health, particularly around learning disabilities, which often coincide with barriers to effective health management and access, leading to an increased risk.”

“We believe that these findings are important to both patients and policy makers […] They indicate that more groups of people are at increased risk for heart and circulatory diseases than previously recognised. These people could and should now benefit from treatments and other preventive measures to reduce their risk.”

Dr Carol Coupland, senior researcher at the University of Oxford and Professor of Medical Statistics in Primary Care at the University of Nottingham and co-author of the study, equally emphasises the significance of the research, believing it has the potential to set “a new standard in cardiovascular risk assessment.” Dr Coupland goes on to explain that when comparing QR4 with established models, QR4 “provides a more detailed risk profile for each individual, allowing for earlier and more precise intervention strategies.” This, she argues, is “crucial” in the field where early detection saves lives.

As part of the evaluation, the QR4 algorithm was tested against some of the most well-established cardiovascular risk assessment tools currently used in both the United States and Europe. It outperformed the most widely used heart disease risk calculators, more accurately identifying high-risk patients. This includes QRISK3, which is recommended by the National Institute for Health and Care Excellence (NICE) in the UK.

This new algorithm builds on almost two decades of work and global leadership in the field of risk algorithms, and cardiovascular risk algorithms in particular. QR4’s predecessor, QRISK is widely used in the NHS to assess over 5 million patients a year, often as part of NHS Health Checks.

Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation hailed the new tool as a groundbreaking development: “This important update to the QRISK tool will allow clinicians to build the clearest picture yet of individuals’ risk of developing heart and circulatory diseases.”

“Informed by large amounts of data from diverse populations, the new and improved algorithm takes vital steps towards improving risk assessment in populations where cardiovascular risk may often go under-detected. The QR4 tool will offer a much-needed, renewed focus on better identifying people at risk and improving the prevention of cardiovascular diseases.”

Meanwhile, Professor Keith Channon, BHF Professor of Cardiovascular Medicine at the University of Oxford, highlighted how the news was particularly promising for overlooked communities, stating, “Cardiovascular risk has been under-recognised in some populations, which through QR4 we can now better address”. He went on to explain how QR4 can “help identify more diverse groups of people who have high cardiovascular risk, enabling them to access interventions and treatments to reduce their risk.”

“Our findings also reveal that women with COPD are at a higher risk of cardiovascular diseases than previously understood,” said Professor Mona Bafadhel, co-author, Chair of Respiratory Medicine, King’s College, London and Asthma + Lung UK Professor. “This underscores the critical need for targeted cardiovascular monitoring and interventions in these patients, which begins with an early diagnosis.”

You can read the full study here: https://pubmed.ncbi.nlm.nih.gov/38637635/#:~:text=QRISK%20algorithms%20use%20data%20from,separately%20for%20men%20and%20women
 

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