Cardiovascular risk assessment by primary-care physicians in Germany and its lack of agreement with the established risk scores (DETECT)

Background: The concordance of several cardiovascular risk scores (PROCAM Score, Framingham Score and ESC Score) and its agreement with the treating physicians' risk assessment is unclear. Methods: For 8,957 nationally representative primary-care patients without known cardiovascular disease (age 40-65 years), the 10-year risk for experiencing a myocardial infarction or coronary death was determined by using various established risk scores in addition to risk prediction by the treating primary-care physician. Results: In this sample, the mean 10-year coronary morbidity risk was estimated by PROCAM to be 4.9% and 10.1% by the Framingham Score. The mean 10-year cardiovascular mortality risk, estimated by the ESC Score, was 2.9%. According to the risk assessment of the primary-care physicians only 2.7% of the patients were assigned to this group. The number of patients assigned to high, medium and low risk differed substantially. Applying the Framingham Score, 22.6% of all patients were assigned to the high-risk group. Concordance in cardiovascular risk categorization between all three scores was present in only 34.0% of all cases. In 5.9% of the patients the three risk scores yielded completely different risk estimations. Only approximately 8% of the patients assigned to the high-risk group according to the different scores were also recognized as high-risk patients by the primary-care physicians. For approximately 48% of these patients the physician allocated a medium risk and for 41-46% even only a low risk. Conclusion: The substantial level of disagreement between the different scores as well as of the scores with the prediction of the treating physicians underlines that risk stratification with the established scores evidently plays no significant role in routine care at this point. Which of the score predictions should be considered to be most sensitive and specific will be examined now prospectively using the 5-year prospective data of the DETECT study.