Use of Cardiovascular Risk Appraisal Systems in UK General Practice

Abstract

Background: Several scoring systems to assess an individual's risk of heart disease are available to practices. This approach has been advocated to focus practice activities on those at highest risk and to assist in individual patient management. Objectives: To determine the use of cardiovascular risk appraisal systems in general practice, and the view of users and non-users. Methods: Postal questionnaire survey to all general practices in Leicestershire (n=153), addresses preferentially to the practice nurse. Results: Responses were received from 126 practices (82%). Twenty-five (20%) used a risk appraisal system. The most popular were practice-devised systems (11 practices), the Dundee coronary risk disk (11) and the coronary risk calculator (4). Of the users, 12 (48%) targeted all within an age range and 12 (48%) used the score selectively with those specific risk factors. Eighteen practices (72%) used the scores both opportunistically and as part of a well person check. The most popular method of presentation was a relative risk (16 practices, 64%) and in all but one practice the result was always or usually revealed to the patient. Thirteen users (52%) felt presentation of risk usually had a motivational effect. Amongst the 102 non-users of a score, the attributes rated most highly were validity, ease of use and motivational impact. Conclusions: Between one in five and one in six practices in Leicestershire use a multifactorial appraisal system to assess risk of heart attack. These scoring systems are being used in three ways; for population screening, to assess risk in selected groups, and as a motivational tool in management of individuals. The diversity of approach and scoring systems used suggests that practices may need more guidance when considering this innovation.