FAQ

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 and uses the risk function from the SCORE2 and SCORE2-OP project. The HeartScore® web-based program estimates 10-year risk of a myocardial infarction, stroke or cardiovascular death, based on age, sex, smoking habits, systolic blood pressure and non-HDL cholesterol. At the end of the consultation, the clinician may print an individual's health advice based on his or her actual risk profile.

SCORE2 and SCORE2-OP are calibrated to four European risk regions, based on age- and sex-standardized CVD mortality rates. Please choose the appropriate region.

Low-risk countries: Belgium, Denmark, France, Israel, Luxembourg, Norway, Spain, Switzerland, Netherlands, and the United Kingdom of Great Britain and Northern Ireland.

Moderate-risk countries: Austria, Cyprus, Finland, Germany, Greece, Iceland, Ireland, Italy, Malta, Portugal, San Marino, Slovenia, and Sweden.

High-risk countries: Albania, Bosnia and Herzegovina, Croatia, Czechia, Estonia, Hungary, Kazakhstan, Poland, Slovakia, and Turkey.

Very high-risk countries: Algeria, Armenia, Azerbaijan, Belarus, Bulgaria, Egypt, Georgia, Kyrgyzstan, Latvia, Lebanon, Libya, Lithuania, Montenegro, Morocco, North Macedonia, Republic of Moldova, Romania, Russian Federation, Serbia, Syrian Arab Republic, Tunisia, Ukraine, and Uzbekistan.

The calculation model used is based on the SCORE-2 project (SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 2021;42:2439-2454.) comprising more than 677,684 individuals and 30,121 CVD events.

2/ What is the SCORE2 and SCORE2-OP Project?

The European Society of Cardiology initiated the development of a new risk estimation system (SCORE2) using data from 45 cohort studies (N= 677,684) covering a wide geographic spread of countries at different levels of cardiovascular risks. The SCORE2 data contains more than 30 121 fatal and non-fatal cardiovascular events. The model was externally validated with data from 25 additional cohorts in 15 European countries (1,133,181 individuals, 43,492 CVD events). Furthermore, a new competing risk-adjusted model was developed for adults aged 70 years and older: SCORE2-OP. Models for SCORE2-OP were derived in individuals aged over 65 without pre-existing atherosclerotic CVD from the Cohort of Norway (28,503 individuals, 10,089 CVD events) and were recalibrated using region-specific estimated CVD incidence rates and risk factor distributions. SCORE2-OP was externally validated using data from 6 additional study populations {338,615 individuals, 33,219 CVD 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 own 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, despite continually striving to ensure the ultimate browsing experience for our website visitors, it could be that our websites do not display in your browser as we would like them to.

This website is optimised for the latest versions of the following browsers:

Chrome (Mac, Windows, iOS, and Android)
Safari (Mac and iOS only, as the Windows version is being abandoned)
Firefox (Mac, Windows)
Opera (Mac, Windows).

Please also note that you still have the possibility to use the paper SCORE2 risk charts. The SCORE2 risk charts are part of the 2021 European Guidelines on CVD Prevention. The executive summary of the guidelines has been published in both the European Heart Journal (Volume 42, Issue 34, 7 September 2021, Pages 3227–3337) and European Journal of Preventive Cardiology (Volume 29, Issue 1, January 2022, Pages 5–115).

5/ Which countries does HeartScore® apply to?

Please refer to countries listed by region in FAQ #1.

6/ Which model in HeartScore® should I choose?

For the European HeartScore® version, you have to choose between the European Low-to-moderate Risk, High Risk and Very High Risk charts.

7/ What about HeartScore National Versions?

The April 2022 release focuses on updating HeartScore with the SCORE2 and SCORE2-OP algorithms. This intermediate release is available in English, for four risk regions (Low, Moderate, High, Very High). We are currently raising funds to deploy this update in translated versions.

8/ I live outside Europe and would like to use HeartScore® with my patients. Which model should I use?

The SCORE-2 / SCORE-2 OP algorithms are based on European datasets for low, medium, high and very high regions of Europe. Should you wish to use the algorithms in countries/regions not included in the original publications, this is at your own discretion and under your sole responsibility.

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 a certain risk percentage. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

10/ 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 male and female patients aged 40-89 years old without diabetes or manifest vascular disease. 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.

11/ Is it possible to use HeartScore® for secondary prevention of CVD?

HeartScore® is solely dedicated to primary prevention in apparently healthy patients. The SCORE2 and SCORE2-OP models are based on data from people without established atherosclerotic cardiovascular 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. Risk stratification tools for secondary prevention include the SMART (Secondary Manifestations of Arterial Disease) risk score (available in the ESC CVD Risk Calculation app and via U-prevent) for estimating 10-year residual CVD risk in patients with stable ASCVD, defined as CAD, PAD, or cerebrovascular disease (81) and the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) risk model, which estimates 2-year risk of recurrent CVD in patients with stable CAD (82).

12/ 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?

HeartScore® was designed for apparently healthy patients only. For more information regarding risk estimation and risk factor treatment in persons with type 2 diabetes mellitus, please see section 3.2.3.8 of the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.

13/ 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 shown to not improve the predictive ability of the SCORE2 and SCORE2-OP algorithms when added on top of age, sex, blood pressure, smoking status and non-HDL-cholesterol.

14/ 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.

15/ What is the rationale for the re-designation of some European countries as low risk regions?

The fact that CVD mortality has declined in many European countries means that more countries now fall into the low-risk category. In SCORE2 and SCORE2-OP, all European countries were grouped into four risk regions according to their most recently reported WHO age- and sex-standardized overall CVD mortality rates per 100 000 population (ICD 10 chapters IX, I00-I99) (13). The four groupings were low risk (<100 CVD deaths per 100 000), moderate risk (100 to <150 CVD deaths per 100 000), high risk (150 to <300 CVD deaths per 100 000), and very high risk (⁠≥300 CVD deaths per 100 000).

16/ How can I access the 2021 European Guidelines on CVD Prevention?

The full text and related materials are available in the guidelines section of the ESC website.

17/ 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: myocardial infarction, stroke or cardiovascular death) happening to a person within a given time range. The prediction in years is set to 10 years. The absolute CVD risk chart consists of two 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 right hand bar shows the risk for the patient’s age category, that would constitute a low-to-moderate risk. (2).

18/ What is meant by risk age?

The risk age of a person with several atherosclerotic CVD risk factors is the age of a person of the same sex with the same level of risk but with low levels of risk factors. Risk age is an intuitive and easily understood way of illustrating the likely reduction in life expectancy that a young person with a low absolute but high relative risk of CVD will be exposed to if preventive measures are not adopted.

19/ I have some ideas on how to improve HeartScore®, who should I contact?

Should you have any suggestion, please contact us.

20/ 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.