WIREDGOV

The National Institute for Health and Clinical Excellence (NICE) has today announced a change to the recommendations in its lipid modification guideline (CG67) on cardiovascular risk assessment. The recommendations advising the use of the Framingham risk assessment tool have been withdrawn, as it is not clear that it is superior to other tools. Healthcare professionals will now instead decide which risk assessment tool is most suitable for their needs.

NICE was aware when the guideline was published in May 2008 that the evidence on cardiovascular risk estimation was developing rapidly, and so recommended that further research was needed on how best to estimate cardiovascular disease risk. In view of the publication in 2009 of more evidence comparing the QRISK tool with other risk estimation tools, NICE’s Centre for Clinical Practice sought a view from members of the original Guideline Development Group (GDG) on whether the new evidence warranted an update of the guideline at this stage. There was no consensus among the members of the group that there was sufficient new evidence to allow for a clear decision in recommending one cardiovascular risk estimation method over another.

NICE’s Guidance Executive considered this feedback and came to the view that, although the evidence has moved on, an update was not appropriate as it did not seem that a clear conclusion would be reached favouring one method over another. In these circumstances the decision was taken to withdraw the guidance relating to a particular method of estimation so that the decision could be left to the NHS locally to use the method best suited to their requirements.

Dr Fergus Macbeth,Director of the Centre for Clinical Practice at NICE, said: “When the original guideline was published the Guideline Development Group could not, on the basis of the evidence or expertise before them, make a decision that one risk assessment equation was clearly superior in the UK population. As QRISK was at the time still a model in development, the GDG could not be confident that its introduction would bring significant benefits. The GDG reasoned that Framingham, despite its known limitations, was currently in use and understood. The GDG felt that continuing to use Framingham in the short term would not compromise individual patient care. Today’s decision acknowledges that both Framingham and QRISK have positive features to recommend them and that the field continues to evolve rapidly. Until, and if, the evidence shows a clear benefit of using one assessment tool over the other we have recommended that healthcare professionals use the tool that best suits their requirements.”

The amended versions of the guideline are available here.