UK Government's Vascular Screening Programme's Flaws

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Main Category: Vascular
Also Included In: Primary Care / General Practice;  Public Health;  Cardiovascular / Cardiology
Article Date: 01 Mar 2009 - 1:00 PDT

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The UK Government's vascular screening programme will most likely misclassify risk in hundreds of thousands of patients and worsen health inequalities, according to research published in the journal Pulse.

Primary Care Trusts are preparing to provide screening for everyone between the ages of 40 to 74 from April 2009, but two teams of researchers have concluded the move will mean well-off men are overtreated with statins, while all women and less well-off male patients will miss out.

The researchers say that the Scottish ASSIGN tool would be far more effective than the Framingham score used in the screening programme at identifying risk in women and socially disadvantaged patients.

A study carried out in the University of Dundee and submitted to the BMJ concludes ASSIGN, which is commonly used in Scotland, is much fairer than Framingham. It reports that among poorer people, ASSIGN identifies 30% of men and 25% of women, versus 34% of men and 19% of women using Framingham.

Study leader Professor Hugh Tunstall-Pedoe, co-developer of ASSIGN and head of the cardiovascular epidemiology unit at the University of Dundee, believes ASSIGN should be used in England and Wales. Tunstall-Pedoe said "ASSIGN abolishes the social gradient in undertreatment of cardiovascular disease, whereas Framingham will be treating a lot of wealthy people who will not go on to develop CVD.'

Meanwhile, the independent evaluation for NICE of Framingham, ASSIGN and the QRISK score - obtained by Pulse under the Freedom of Information Act - also backs ASSIGN.

The study carried out by researchers from the University of East Anglia demonstrated that ASSIGN had better discrimination than Framingham and QRISK and should be considered as an 'alternative model' for CVD risk assessment.

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Written by Christian Nordqvist
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