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Framingham Risk Calculator
Supporting 2016 CCS Lipid Guidelines

And 2015 Simplified Lipid Guidelines

Case Finding (Who to Screen)

About Document Origins

 

Instructions

 

This calculator uses the Framingham risk score to evaluate cardiovascular risk according to the most recent Canadian guidelines. See Installing the Calculator for instructions on how to do the installation. The screen will initially come up for women. Be sure to select the appropriate gender using the radio buttons. Gender will be color coded as a reminder.

 

Data Input

 

Input in the left column includes the risk factors of the Framingham Risk Score (FRS). Calculation of risk will proceed in real time as you enter the data, and you can change values as you wish to demonstrate reduction of risk if any of these factors are modified. For example, if the patient contemplates quitting smoking, you can demonstrate change in risk by absolute risk reduction, number needed to treat or by graph. Cardiovascular age is calculated as well. Several warning screens will appear in certain circumstances:

 

o     Blood pressure must be entered prior to entry of BP treatment status

o     Diabetes within a certain age group will receive a statin treatment reminder

o     ASA treatment benefit is not shown past age 80. Any ASA recommendation will not appear until all risk factor data including family history is entered.

o     All risk factors must be entered before diabetes if the patient is diabetic.

o     All risk factors including diabetic status must be entered before family history if there is a history in a first degree relative before age 60

You do not need to start over if a warning screen has appeared.

It is important to reset the calculator using the Start Over button if a lot of changes have been made, or if you are entering values for a new patient. You can return to this screen using the Help button.

 

Interventions

 

There are 5 quantifiable interventions available once data entry has been completed, although data completion is not necessary. Relative risk reduction is indicated on the entry button for each. Only one intervention can be evaluated at a time, but different interventions can be compared if you Return to Calculator and press an alternate button. The entered data will be preserved until you Start Over.

Choosing an intervention will yield the modified FRS, absolute risk reduction, number needed to treat and a graphic representation of the comparison between treated and untreated patients:

 

         Those having no events

  • Those predicted to have an event in 10 years
  • A single bar for events prevented

Cardiovascular age will display during intervention calculation, but this figure may not be particularly accurate.

 

Outcomes Display

 

This occupies the right side of the screen. Changes occur in real time as data is entered or changed. On initial data entry without intervention, the FRS and the percentage of patients unaffected will appear. The graphic will follow these numbers as percentage untreated having events or no events. Cardiovascular age will change as data is entered and risk changes. As the FRS is calculated, level of risk and recommendations regarding treatment threshold and targets are displayed. Diabetes uses a slightly different algorithm, but the text recommendation will appear if the appropriate age range and Framingham risk have been entered. Positive family history changes the FRS by a multiple, so requires all other values to be entered.

 

The ASA recommendation is simply a consideration for patients with a Framingham score over 20%. It will only be valid when data entry is complete and if ASA therapy could be considered. Effect is modest in primary care, and men are most likely to benefit. Bleeding risk must be part of the decision.

 

When an intervention is selected there will be percentage and graphical representation comparing those with no events, those with predicted 10 year events and events prevented. This is a 1 time calculation, and it will disappear when you return to the calculator, however the calculation can be repeated with a different intervention. You can use Print Screen if you need hard copy.

 

Installing the Calculator:

The calculator may be run from the website, however it will probably be faster to have the application run from your hard drive. The source files can be downloaded as Framingham Risk Calculator.zip from the calculators menu page or from here.

  1. It is suggested that you unzip these files to a newly created folder. All the files must be in the same folder otherwise hyperlinks will not function.
  2. Run the application from the file titled Framingham Risk Calculator.htm. This file has hyperlinks to the calculator. Documentation can be accessed from here as well.
  3. There are 2 calculator formats. There is no longer an option for US units, as the risk equations validated in US guidelines are now different. Once you decide on a format you prefer, you can create a desktop icon which will go directly to that format by referencing a specific file:

         Standard CCS calculator with graphic interface in SI units CCSFramingham.html

         CCS calculator with dyslipidemia support in SI units .... CardMetRisk.html

         The AHA/ACC calculator option has been removed, as the Simplified Lipid Guidelines are now represented in decision support along with the new CCS Guidelines. This now allows treatment based on risk rather than lipid levels.

  1. Create an icon for your desktop if you wish by right-clicking in Windows Explorer on one of the above files and select Send to > Desktop (create shortcut). Double clicking on this icon will then open the calculator application. In Windows 7, right-click on the file and select Create Shortcut. The shortcut produced in Explorer can then be dragged to the Desktop. Change the icon and title if you wish.
  2. This is a javascript based application, so javascript must be enabled in your browser. So far it is tested in Firefox, Google Chrome Safari and Internet Explorer.