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Potential loss of access to integrated QRISK tool for users of EMIS IT systems

General practices using EMIS IT clinical systems may have noticed an error message advising them that access to the QRISK2 risk calculator will cease from 31 March 2023.

Tue 14th March 2023 The PDA

QRISK is a widely used algorithm for predicting cardiovascular risk in individuals. It estimates the risk of a person developing cardiovascular disease (CVD) over the next 10 years when applied to people between the ages of 35 and 74 years. Anyone with a QRISK score above 20% is considered as high risk of developing CVD.

Software supplier EMIS have this week confirmed that following discussions with NHS England and the Medicines and Healthcare Regulatory Authority (MHRA)  they will be able to continue providing the integrated QRISK2 tool until 2024. Practices can therefore ignore the error message which may remain on systems until April 2023.

The updated QRISK3 risk calculator recommended for introduction in the draft NICE guidance: Cardiovascular disease: risk assessment and reduction, including lipid modification[GID-NG10178] does not have a confirmed date for introduction.

EMIS are unsure of when the QRISK3 tool will be integrated into clinical systems, but NHS England has advised that continued use of integrated the QRISK2 tool is the safest approach until further notice.

Clinicians should be aware that whilst they will need to continue using QRISK2 until QRISK3 becomes available, this will result in the exclusion of 7 additional variables noted in the draft NICE guidelines, which have been added to QRISK3. These are:

A diagnosis of:

  1. Migraine
  2. Systemic lupus erythematosus (SLE)
  3. Severe mental illness
  4. Erectile dysfunction (or being treated for)

Prescriptions for:

  1. Corticosteroids
  2. Atypical antipsychotics and:
  3. A measure of systolic blood pressure variability.

Whilst the QRISK website lists an 8th variable which differs from QRISK2 (chronic kidney disease which now includes CKD3). The committee felt that the evidence on the performance of QRISK3 wasn’t sufficient to suggest changing the 2014 recommendation against using a CVD risk tool in patients with CKD. This group should be treated as high risk (similarly to those with Type 1 diabetes and hypercholesterolaemia).

The PDA advises members who utilise cardiovascular risk calculators as part of their role to:

  • Ignore the error message regarding the removal of QRISK2 from the clinical system.
  • Continue to utilise the integrated QRISK2 tool until further notice.
  • Familiarise themselves with NICE draft guidance [GID-NG10178]
  • Familiarise themselves with QRISK3.

Learn more

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