Mapping the expanded often inappropriate use of the Framingham Risk Score in the medical literature

Tzoulaki, Ioanna; Seretis, Aristeidis; Ntzani, Evangelia; Ioannidis, John P. A.

doi:10.1016/j.jclinepi.2013.10.021

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…124 The FRS was developed in a non-Hispanic white population with a mean age of 49 years (range 30-74 years). Tzoulaki et al 125 recently evaluated the use of the FRS in the scientific literature from the original publication of the FRS in 1998 to April 2011 in 375 articles. The majority of articles used the score to quantify cardiovascular risk in populations distinct from the Framingham cohort population and assessed outcomes distinct from those for which the FRS was developed.…”

Section: Framingham Risk Scorementioning

confidence: 99%

Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations

Rao¹,

Powell‐Wiley²,

Ancheta³

et al. 2015

Circulation

133

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Section: Framingham Risk Scorementioning

confidence: 99%

Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations

Rao¹,

Powell‐Wiley²,

Ancheta³

et al. 2015

Circulation

133

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“…Previous studies have assessed the cost-effectiveness of health check programs versus usual care in six European countries [ 5 , 6 , 30 , 31 ] and Australia [ 7 ]. These studies simulated regular health checks (5 yearly) for patients aged 40–75 years with no pre-existing CVD or diabetes; subsequent interventions were specified to manage detected risk factors [ 32 ]. Three of these modelling studies adopted Cost-Effectiveness Analysis (CEA) [ 5 – 7 ] and the other two were Cost-Consequence Analysis (CCA) [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…To predict CVD incidence in the baseline cohort, the Framingham risk equation (FRE) was applied to individuals in the simulated hypothetical cohorts. Acknowledging concerns about the generalizability of the FRE, and its applicability to all CVD outcomes [ 32 ], we carefully considered the applicability of the FRE to our study. The application of the FRE to Australian cohorts has been validated and recommended in clinical practice [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…While the model presented reasonable estimates of CHD incidence, it consistently underestimated CVA incidence. It has been argued that the FRE was initially developed to predict CHD risk rather than other forms of CVD [ 32 ]. However, the influence was not substantial given the generally low CVA incidence in the target population (0.12% in male and 0.10% in female).…”

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness evaluation of the 45-49 year old health check versus usual care in Australian general practice: A modelling study

Moss

Karnon

et al. 2018

PLoS ONE

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ObjectivesTo assess the potential cost-effectiveness of the 45–49 year old health check versus usual care in Australian general practice using secondary data sources.MethodRisk factor profiles were generated for a hypothetical Australian cohort using data from the National Health Survey. Intervention effects were modelled based on a meta-analysis on risk factor changes in the 5 years after a health check. The Framingham Risk Equation was applied to estimate the 5-year cardiovascular disease (CVD) incidence in the health check and usual care group respectively. A Markov model was then constructed to extrapolate long-term CVD outcomes, health care costs and Quality Adjusted Life Years (QALYs) in both groups. Health check-related costs, applied to the health check group, were estimated from clinical guideline and experts’ opinion. Lifetime costs, applied to both groups, included costs of hospitalization for CVD events and associated post-event health service use. The Incremental Cost-Effectiveness Ratio (ICER) was calculated for male and female patients respectively.ResultsCompared to usual care, the health check reduced CVD incidence for both males (RR = 0.87) and females (RR = 0.91) over a 5-year time. In a lifetime projection, health check led to an average 0.008 and 0.003 QALYs gained per male and female participants respectively. The estimates ICERs were AU $42,355 and AU $133,504 per QALY gained for males and females, respectively. A probabilistic sensitivity analysis demonstrated a probability of cost-effectiveness of 17.5% and 0% for male and female attendees, assuming a willingness to pay threshold of AU $28,000 per QALY gained.ConclusionThe 45–49 year old health check is associated with a small expected QALY gain per participant, though the persons avoiding CVD events experience large health gains. The mean ICER is larger than an empirical estimate of the threshold ICER and the evaluated health check is highly unlikely to be cost-effective.

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“…Inappropriate use of the FRS has been documented 16. Our sensitivity analyses suggested that age restriction is particularly important when using the point-based version of the Framingham CVD algorithm.…”

Section: Discussionmentioning

confidence: 87%

Challenges in reproducing results from publicly available data: an example of sexual orientation and cardiovascular disease risk

Austin

Harper

Kaufman

2016

J Epidemiol Community Health

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Mapping the expanded often inappropriate use of the Framingham Risk Score in the medical literature

Cited by 11 publications

References 18 publications

Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations

Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations

Cost-effectiveness evaluation of the 45-49 year old health check versus usual care in Australian general practice: A modelling study

Challenges in reproducing results from publicly available data: an example of sexual orientation and cardiovascular disease risk

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