Contributing to EPIC-CVD: Implementation of new cardiovascular risk assessment tools across Europe

Background

EPIC-CVD is an EU funded, pan-European initiative that involves 28 partners across 10 European countries. It aims to provide clinicians and policymakers with a range of evidence-based policy options for cost-effective, individualised risk assessment for cardiovascular disease in EU countries.

Through the Cambridge Centre for Health Services Research, RAND Europe contributed to a work package, in collaboration with the PHG Foundation, which sought to explore options for the implementation of new cardiovascular risk assessment tools across Europe.

Goals

To help inform policy options, researchers aimed to better understand what was currently being done in day-to-day practice across Europe. Through a combination of stakeholder surveys and case studies, they sought to assess the range of activities around cardiovascular risk assessment that are routinely used in European countries, and options for introducing advanced risk assessment tools using novel biomarkers that were being developed as part of EPIC-CVD.

The study explored the extent to which introducing such tools in clinical practice would be feasible and acceptable for patients, clinicians and funders, as well as the regulatory environment that might influence options.

Methodology

Data were collected from academics, clinicians and policymakers in an online questionnaire targeted at experts from all European Union member states, and in eight in-depth country case studies that were developed from a targeted literature review and 36 interviews.

Findings

• The European Society of Cardiology (ESC) produces European guidelines for CVD risk assessment and recommends the Systematic COronary Risk Evaluation (SCORE) tool, which is the most widely used risk assessment tool in Europe.
• The use of risk assessment tools is variable, and lack of time and resources are important barriers.
• Integrating risk assessment tools into clinical systems and providing financial incentives to carry out risk assessments could increase implementation.
• Novel biomarkers would need to be supported by evidence of their clinical effectiveness and cost-effectiveness to be introduced in clinical practice. These findings were consistent across Europe.

Conclusions

• The ESC is important in CVD risk assessment and any changes in European risk assessment policy should be made by, or in collaboration with, the ESC.
• Increasing the use of existing risk assessment tools is likely to offer greater gains in primary prevention than the development of novel biomarkers.

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Project Team

Jo Chataway
Eleanor Winpenny
Teresa Bienkowska-Gibbs
Jennie Corbett
Calum Maclure
Rupert Payne, CCHSR