QRISK3

Please note that at this current time, these services are not available for use in a live environment and must not be used. The following information is made available in advance of go-live

Background

Information about QRISK3 and the free to use Web site can be viewed https://qrisk.org

Integration with systems

Systems may have access to longitudinal health records, in particular those held in General Practice. In that case those systems may elect to use QRISK in a way that provides likely values for the variables used in the algorithm, those values being derived from the records.

That being the case, a set of query criteria and rules are applied to the record entries and the values of the variables derived. These are then presented to a user for confirmation, or amendment before being submitted as a set of parameters to the function via an API.

It is strongly recommended that for any individual decision, or potential entry of the risk score in the record, that each set of assumptions are confirmed. Purely automated calculations may be used for population based risk stratification in order to plan interventions.

Patient inclusion criteria

This section documents the criteria for a person suitable for the application of QRISK3

All dates are relative to the time at which the algorithm is applied to the patient and is referred to as the reference date.

• Aged between 25 and 84 inclusive at the reference date

• Free from a diagnosis of cardiovascular disease on or before the reference date

Variables and function parameters

QRISK® operates as a function whose parameters represent independent variables. The values of those variables, when used in the algorithm are derived in one of two ways

a) By direct entry by a user

b) By a query of a health record.

When passed into the algorithms as arguments to the function, the values are presented either as a double, an integer, a boolean 1 or 0, or a character. The client must convert to these formats before submitting as arguments (e.g. as case statement)

If variables are unknown (missing) or their values are out of range, the algorithm may either reject the request, provide a default value, or adjust the out of range value to an outer limit.

Each concept set has an IRI and the iri namespace is http://apiqcodes.org/qcodes#. Which uses the iri prefix qr in the following table

Input parameters needed to calculate a QRISK3® score and their handling are as follows:

Parameter	Data type	description	Values	Concept Sets	Rules	Missing or out of range adjustments
row number	integer	An id that is returned in the result in order to reconcile with the client. Its scope relates only to the specific request response and thus only relevant for bulk calculation
age	Integer	Patients age in years on the refence date				Reject if missing
gender	Character	Patient gender of male or female.	M or F			Reject if missing Binary values only accepted. QRISK does not have information on transgender or indeterminate gender risks at this stage. It is the responsibility of the requester as to whether to apply the higher risk M gender e.g. For Trans Women
cvd	boolean	Cardiovascular disease prior to the reference date	1 or 0	??	Any entry effective Date < reference date	Reject if true. Whilst the patient is not suitable for a score , this parameter is supported as a second line assurance
af	boolean	Atrial fibrillation at any time prior to reference date.	1 or 0	qr:24		Assumes 0 by default QRisk does not differentiate a single one off AF event from chronic or intermittent AF. Clinical interpretation may be required for those with a single event many years ago.
atypicalantipsychotics	boolean	Second generation ‘atypical’ antipsychotic - prescribed two or more issues in the previous 6 months (includes amisulpride, aripiprazole, clozapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, or zotepine)	1 or 0	qr:1169	Medication requests, effective date within 6 months prior to reference date Count (entry)>=2	Assumes 0 by default.
corticosteroids	boolean	systemic corticosteroids –prescribed two or more issues in the previous 6 months	1 or 0	qr:1194	Medication requests, effective date within 6 months prior to reference date Count (entry)>=2	Assumes 0 be default
migraine	boolean	Diagnosis of migraine prior to the reference date 39	1 or 0	qr:39	any effective prior to reference date	Assumes 0 by default
rheumatoidArthritis	boolean	Diagnosis of Rheumatoid arthritis prior to the reference date	1 or 0	qr:58	any effective date prior to the reference date	Assumes 0 by default
renal	boolean	Chronic renal disease at any time prior to the refernce date	1 or 0	qr:322	any effective date prior to the reference date	Assumes 0 be default
severementalIllness	boolean	Diagnosis of severe mental illness (psychosis, severe depression, manic depression, schizophrenia) at any time prior to the refernce date	1 or 0	qr:3187	any effective date prior to the reference date	Assumes 0 to be default
sle	boolean	Diagnosis of systemic lupus erythematosis at any time prior to the reference date	1 or 0	qr:70	any effective date prior to the reference date	Assumes 0 to be default
treatedHypertension	boolean	diagnosis of hypertension at any time in the patient’s records AND On antihypertensive treatment if 1 or more medication requests within 6 months prior to the reference date.	1 or 0	(hypertension qr:21) (medication qr:740 qr:751 qr:759 qr:760 qr:765 to be revised)	(hypertension effective date prior to refence date) and (Medication requests, effective date within 6 months prior to reference date	Assumes 0 by default
bmi	double	The most recently recorded body mass index for the patient recorded prior to the search date recorded in the last 5 years.		qr:200	effective date within 5 years prior to reference date. Latest entry, numeric value	<18 is set to 18 >47 is set to 47 if null uses estimate value
diabetesCategory	integer	categorical variable to denote no diabetes, type 1 diabetes or type 2 diabetes diagnosed at any time prior to the refernce ate and	0 or 1 or 2 or	qr:1913 rq:2411	any effective date prior to the reference date most recent effective date entry, categorise as qr:1913= 1 qr:2411 = 2	Assumes 0 by default
ethnicity	integer	17 caregories	0 to 17	qr:17087= Not recorded qr:17071 = White british qr:17072 =White Irish qr:17073 =Other White Background qr:17074 =White & Black Caribbean qr:17075 =White & Black African qr:17076 =White & Asian qr:17077 =other mixed wr:17089=Indian qr:17079 =Pakistani qr:17080 Bangladeshi qr:17081 =Other Asian qr:17090 =Caribbean qr: 17083=Black African qr:17091 =Other Black qr:17985 =Chinese qr:17086 Other ethnic group qr:17087 Note recorded ->17	latest from all groups then 17087 = not recorded -> 0 qr:17071 = White british->1 qr:17072 =White Irish ->2 qr:17073 =Other White Background->3 qr:17074 =White & Black Caribbean->4 qr:17075 =White & Black African->5 qr:17076 =White & Asian->6 qr:17077 =other mixed->7 wr:17089=Indian->8 qr:17079 =Pakistani->9 qr:17080 Bangladeshi->10 qr:17081 =Other Asian->11 qr:17090 =Caribbean->12 qr: 17083=Black African->13 qr:17091 =Other Black->14 qr:17985 =Chinese->15 qr:17086 Other ethnic group->16 qr:17097 Not recorded->17

ethnicity

Integer

Ethnic group in 17 categories.

n/a

0 =not recorded

1 =British

2 =Irish

3 =Other White Background

4 =White & Black Caribbean

5 =White & Black African

6 =White & Asian

7 =other mixed

8 =Indian

9 =Pakistani

10= Bangladeshi

11 =Other Asian

12 =Caribbean

13 =Black African

14 =Other Black

15 =Chinese

16 Other ethnic group

17 Not stated

fh_cvd

Boolean

Family history of coronary heart disease in a first degree relative under the age of 60 years recorded before the search date

404

1 = yes, 0 = no

rati

Double (nullable)

The most recent ratio of total serum cholesterol/HDL recorded in the last 5 years. The ratio is either directly directly recorded (eg using group 405) or can be calculated using group 16 divided by group 367

16

367

405

n/a

smoke_cat

Integer

(nullable)

The most recently recorded smoking status 5 levels i.e.

• non-smoker (group

2239

2238

0= non smoker

1 =ex-smoker

QRISK® 3 10-year Risk Search Definition

© Copyright, ClinRisk Ltd 2023

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2239)

• Ex-smoker(group 2238)

• Light-smoker(group 2244)

• Moderate-smoker(group 2242)

• Heavy-smoker (group 2243)

2244

2242

2243

2 =light smoker

3= moderate smoker

4= heavy smoker

Null if missing

sbp

Integer (nullable)

The most recent systolic blood pressure prior to search date recorded in the last 5 years

198

n/a

sbps5

Double (nullable)

Standard deviation of all of the available systolic blood pressures prior to the search date recorded in the last 5 years

198

n/a

town

Double (nullable)

The Townsend score associated with the output area of a patient’s postcode based on the 2001 census data.

n/a

n/a

postcode

String

Patient’s postcode. This can be missing if Townsend score is supplied.

n/a

n/