Clinical Scorecard: Reevaluation of Cardiovascular Risk Assessment in Primary Care: Addressing SCORE2 Model Limitations

At a Glance

Key Highlights

• The SCORE2 model underestimates the 10-year risk of cardiovascular events in primary care patients, predicting 6.2% risk versus an observed 10.1%.
• Underestimation occurs across sex and age groups, with observed-to-expected (O/E) risk ratios ranging from 1.54 to 1.78.
• Approximately 35% of patients may miss preventive treatments due to SCORE2’s underestimation of risk.

Guideline-Based Recommendations

Diagnosis

• Use SCORE2 model to estimate 10-year risk of fatal and non-fatal cardiovascular events in adults aged 40–69 years.
• Consider country-specific risk calibrations when applying SCORE2 in primary care settings.

Management

• Recommend preventive interventions for patients with SCORE2 risk ≥10%, or ≥7.5% for those under 50 years.
• Focus on blood pressure reduction, smoking cessation, lipid lowering, weight management, and physical activity promotion.

Monitoring & Follow-up

• Follow up patients regularly to reassess cardiovascular risk and treatment efficacy.
• Monitor key risk factors including systolic blood pressure, cholesterol levels, smoking status, and diabetes control.

Risks

• Be aware that SCORE2 may underestimate cardiovascular risk in primary care populations, potentially leading to undertreatment.
• Consider additional clinical judgment or recalibration of risk models to avoid missing high-risk patients.

Patient & Prescribing Data

Adults aged 40–69 years undergoing cardiovascular risk assessment in Dutch primary care

Due to SCORE2 underestimation, a significant proportion of patients may not receive indicated preventive therapies, highlighting the need for model recalibration or supplementary risk evaluation.

Clinical Best Practices

• Use SCORE2 risk estimates as part of a comprehensive cardiovascular risk assessment, not in isolation.
• Consider local population data and possible model recalibration to improve risk prediction accuracy.
• Engage patients in shared decision-making regarding preventive interventions based on individualized risk profiles.
• Prioritize modifiable risk factors such as hypertension, smoking, diabetes, and hypercholesterolemia in management plans.

References

• SCORE2 model development and validation
• Integrated Primary Care Information (IPCI) database
• World Health Organization cardiovascular mortality data