Abstract 10947: A Polygenic Risk Score Added to a QRISK2 Cardiovascular Risk Calculator Demonstrated Robust Clinical Acceptance in the Primary Care Setting

Abstract

Introduction: We have previously shown that combining a polygenic risk score (PRS) for cardiovascular disease (CVD), a numerical summary of an individual’s genetic predisposition to CVD, with standard clinical risk calculators such as ASCVD-PCE and QRISK results in improved estimates of CVD risk. Implementation of such a cardiovascular integrated risk tool (CVD IRT) into real world clinical practice is a key focus for further study. Hypothesis: We assessed the hypothesis that a CVD IRT can be incorporated into routine primary care. Methods: The Healthcare Evaluation of Absolute Risk Testing Study (NCT05294419) is a prospective trial recruiting up to 1,000 healthy participants undergoing health checks across 12 UK NHS general practices. Both QRISK2 and CVD IRT scores were generated and returned to clinicians, who then communicated the results to participants. The primary outcome of this study is operational success as well as feedback from health care providers (HCPs) and participants. The study also measures the impact of the CVD IRT on clinical decision making. Results: These are interim analyses. As of April 2022, 624 eligible participants (62% female, mean age 55) have been recruited. A total of 371 CVD IRT reports have been generated, with 100% of blood samples generating scores that were all returned within the designated time frame. Among the primary care HCPs, 89% (8/9) agreed that the incorporation of CVD IRT into routine care could be done in a straightforward manner. Among the participants who have completed a survey to date, 93% (125/135) would likely or very likely recommend the CVD IRT to friends and family. Average QRISK2 (6.3%) and CVD IRT (6.6%) risk scores did not differ significantly, but there were broad changes in risk among individual patients, with 5% (19/371) of patients crossing above the risk threshold to treat according to NICE guidelines (10-year risk ≥ 10%) as well as 3% (11/371) of patients reclassified as very high risk (10-year risk ≥ 20%). Conclusions: The rollout of an integrated risk tool combining polygenic risk into a standardized CVD risk calculator within primary care is feasible and well accepted by clinicians and participants. The CVD IRT results suggest clinically actionable changes in a substantial proportion of this population.