1/ What is HeartScore ®?
HeartScore® is a risk prediction and management web-based program aimed at supporting clinicians in optimising individual cardiovascular risk reduction. The HeartScore® web-based program is based on the internet technology and uses the risk function and data from the SCORE project.
The HeartScore® web-based program estimates risk of cardiovascular death, based on age, sex, smoking habits, blood pressure and blood cholesterol or the total cholesterol/HDL ratio. It shows absolute CVD risk in a bar-chart and the Contribution of modifiable risk factors to total risk in a pie chart. The expected effect of intervention is calculated from large randomised clinical trials in hypertension and hypercholesterolaemia. At the end of the consultation, the clinician may print an individual's health advice based on his or her actual risk profile. At the moment, European (High & Low) and National versions are available. However, the program is designed so as to handle its adaptation to local conditions (national calibrated charts and translation) by the National Cardiac Societies.
The European HeartScore® versions are currently available in English and include two models: "European Low Risk" for Belgium*, France, Greece*, Italy, Luxembourg, Spain*, Switzerland and Portugal and "European High Risk" for all other European countries. The calculation model used is based on the SCORE project (Conroy R.M., Pyörälä K., et al.:"Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project". European Heart Journal (2003) 24:987-1003) comprising more than 200.000 individuals. The national models will be based on a calibration of this function to national mortality statistics.
Note: *Updated, re-calibrated charts are now available for Belgium, Germany, Greece, the Netherlands, Spain and Sweden.
2/ What is the SCORE Project?
The European Society of Cardiology initiated the development of a new risk estimation system (SCORE) using data from 12 European cohort studies (N=205,178) covering a wide geographic spread of countries at different levels of cardiovascular risks. The SCORE data contains more than 3-million person-years of observation and 7,934 fatal cardiovascular events.
3/ Who can use HeartScore®?
HeartScore® has been developed for use in clinical practice, and may be used by clinicians as well as nurses and any other health professionals involved in the primary prevention of CVD. HeartScore® may also be used for research purposes. HeartScore® is not intended to be used by people without a clinical background. The message conveyed by HeartScore® regarding the absolute and relative CVD risk of an individual must never stand alone and should always be communicated by health professionals.
Risk information should be carefully adapted to the resources of individual patients. The intention behind the HeartScore® web-based program is not to impose unnecessary risk knowledge on a large group of people if they are not prepared to cope with the changes in lifestyle proposed. The idea is that doctor and patient determine together the risk reduction which will give the best results and which will be adapted to the individual patient and his or her ability to cope with these life-style changes. The HeartScore® web-based program may also be used in cases where there is doubt as to whether a certain patient has a high risk of developing a cardiovascular disease or if the patient requires an overview of his risk profile and suggestions on how it can be changed.
4/ I would like to use HeartScore®, but I don’t have Windows on my computer
The use of Windows as Operating System is not required with the HeartScore® web-based program.
However, please note that the HeartScore® web-based program has been optimised for Internet Explorer 6.0 web browser under the Windows XP operating system.
If you can’t use HeartScore® web-based program from a different web browser and/or operating system, please contact us. Please also note that you still have the possibility to use the paper SCORE risk charts. The SCORE risk charts are part of the 4th European Guidelines on CVD Prevention. The executive summary of the guidelines has been published in both the European Heart Journal and in the European Journal of Cardiovascular Prevention and Rehabilitation.
5/ Which countries does HeartScore® apply to?
The HeartScore® web-based program has been created for use by European clinicians and physicians in the countries where the ESC is represented by a National Society of Cardiology.
6/ Which model in HeartScore® should I choose?
For the European HeartScore® version, you have to choose between the European Low Risk and High Risk charts.
For the national versions, since you first have to choose the country in which you practice your prevention activity, you don’t really choose the model except if many models are available for this country.
7/ I have heard that national versions of HeartScore® will be available, is it correct?
The HeartScore® web-based program is currently available in English for the European version and several National Versions have been launched. Please contact your National Cardiac Society to learn more about the development of HeartScore® in your country.
8/ I would like to know more about the risk concept used in HeartScore.
The absolute CVD risk is defined as the probability of a clinical event (here: CVD death) happening to a person within a given time range. The prediction in years is set to 10 years.
The CVD absolute risk chart consists of three bars:
- The left hand bar is the patient's risk at the examination date. It shows the patient's absolute risk of a CVD event within the next ten year period (1).
- The middle bar shows the relative risk. This chart may be used to show younger people at low total risk that, relative to others in their age group, their risk may be many times higher than necessary. This may help motivate decisions about avoidance of smoking, healthy nutrition and exercise, as well as flagging those who may become candidates for medication.
- The right hand bar shows the risk if the patient achieves the treatment goals.
It should be noted that the HeartScore® web-based program is about predicting an event and represents a major step away from population surveys (groups) towards individuals. It is therefore important to make it clear to the patient that the program indicates the probability that something will happen.
9/ I would like to use HeartScore®, but I’m concerned that the use of the program may interfere with the way I treat my patients.
The HeartScore® web-based program has not been developed to replace the clinical judgement of the doctor, but rather to support and supplement it. The HeartScore® web-based program does not interfere with how you should treat your patients, or at what level of risk you initiate treatment. This is, of course, still your choice as a physician. According to the European Guidelines on CVD Prevention, it is recommended that treatment should be initiated if the 10-year risk of cardiovascular disease death exceeds 5%. In younger individuals, the relative risk chart should be used. Simple overwriting in the age box can alter the age of the patient. If the 10-year risk exceeds 5%, treatment should be initiated.
10/ When will HeartScore® be updated?
HeartScore® has been offered for national endorsement to all 50 member societies of the ESC. The country- specific versions will be developed in close collaboration with National Societies of Cardiology. Contact your National Cardiac Society for more information on the development of HeartScore® for your country or visit: http://www.heartscore.org/default.htm
11/ I live outside Europe and would like to use HeartScore® with my patients. Which model should I use?
The risk estimations in the web-based program are based on the SCORE-project which solely includes data from Europe. If you want to use the web-based program in countries outside ESC member countries, this is at your own discretion and under your sole responsibility.
12/ Which types of patients would benefit from the use of HeartScore®?
HeartScore® is developed for the primary prevention of cardiovascular disease and it may be used with all male and female patients between 40 and 65 that you see in your clinic. The HeartScore® web-based program may be used in cases where there is doubt as to whether one patient has a high risk of developing a cardiovascular disease, or if the patient requires an overview of his risk profile and suggestions on how it can be changed.
13/ I would like to use HeartScore® on computers that don’t have Internet access. Would it be possible to obtain a CD-Rom of the program?
A stand-alone (PC) version of HeartScore® can also be downloaded at http://www.heartscore.org/default.htm
14/ I have some ideas on how to improve HeartScore®, who should I contact?
Should you have any suggestion, please contact us
15/ Is it possible to use HeartScore® for secondary prevention of CVD?
HeartScore® is solely dedicated to primary prevention. The SCORE model used for the risk score only contains data from people without established disease. However, as defined in the European Guidelines on CVD Prevention, patients with established CVD are per definition at high total risk of further cardiovascular event.
16/ I would like to use HeartScore® with patients who suffer from diabetes; however, HeartScore® does not include diabetes as an independent risk factor. How do I accommodate these patients?
In the European Guidelines on CVD Prevention, it is not recommended to assess risk in patients with diabetes. They have by their lack of glucose control declared themselves at high risk and should therefore be treated with maximum intensity. HeartScore® uses data from the SCORE study and in this study the definition of diabetes varied between the 12 centres who supplied their data. The SCORE group is actively pursuing ways to incorporate diabetes into the model, but it will take some time until this task is fulfilled.
17/ I am considering using HeartScore® but I’m concerned by the fact that the program does not incorporate body mass index as an independent risk factor.
The addition of body mass index (BMI) into the model has been tested several times and BMI has been proved to be a very weak risk factor for CVD. Also, the addition of BMI does not improve the predictive ability of the program.
18/ I noticed that the risk predictions in HeartScore® are different from the published SCORE risk charts.
If you compare HeartScore® with the published paper charts of the European Guidelines on CVD Prevention you will notice minor differences. This is due to the use of two different statistical models. The published charts use a Weibul-model with specific models for each sex. HeartScore® uses a Cox-model with sex as a risk factor. If you have any doubts about using HeartScore®, it is recommended that you use the published paper charts.
19/ Patient Considerations
The HeartScore® web-based program does not change the need to compare a patient's resources with the actual risk load. If the patient is in a situation which at that particular point in time excludes major changes in lifestyle, or if the patient is characterized by several non-modifiable risk factors, the program should only be used after careful consideration.
For some patients, this way of presenting a personal prognosis for the future may seem overwhelming. It should be remembered that it is in fact "only" based on probabilities. We never know who actually avoids disease because of treatment.
20/ How can I get a paper version of the new European Guidelines on CVD Prevention?
The executive summary and the full text are available in PDF format in the guidelines section of the ESC web site.
21/ The FAQ does not answer my questions, what should I do?
If you have any query regarding the HeartScore® program which is not dealt with in the FAQ, please contact us