Table 3 Comparison of advantages and disadvantages between QRISK® risk calculator and WHO/ISH risk charts

Advantages

1. Dynamically updated CVD risk score developed from annually updated anonymized e-health records to reflect changes in the population characteristics

2. Various ethnicity and deprivation groups are included in calculating the CVD risk score for population groups most likely disadvantaged by the other risk algorithms

3. Additional modifiable risk factors and ongoing clinical conditions are included to quantify the CVD risk score for every individual patient

4. CVD Risk scores could be saved through digital online platforms if embedded within mobile or computer applications

5. Upgradeable to a national comprehensive CVD risk factors profile and a rank-ordered recall list

1. Charts can be used even in resource-constraint healthcare settings due to simple variables

2. Allow improvement and effectiveness of CVD risk assessment even in the countries that do not possess sophisticated technology for the use of online calculators through established health information systems

3. The WHO/ISH risk charts provide an optimal visual illustration when explaining the implications of elevated CVD risk to the patients through colour-coded CVD risk categories [24]

Disadvantages

1. Some data are usually missing due to the submission of several CVD risk factors; an estimated QRISK® score is usually calculated using the previously recorded data and predicted values based on the patient's ethnicity, age, and sex

2. High costs are needed for incorporating into a primary health setting with an appropriate computer system and costly screening investigations and examinations are needed for complete “actual” QRISK® CVD risk assessment

3. Patients presented with a QRISK® score acknowledged their CVD risk level, but it is usually unclear if they correctly understood the 10-year CVD percentage risk. It needs after-score recommendations and lifestyle modifications to prevent the poor patient recall of CVD risk, confusion or misunderstanding [39]

1. Results will be only applicable to the country with the largest population in the region

2. Charts underestimate the risk in several groups of people, e.g. Hypertensive with blood pressure persistently ≥ 160/100 mm Hg, people with blood cholesterol ≥ 8 mmol/l, diabetics, people with a history of diagnosed ischemic heart disease or renal patients [40]

3. The WHO/ISH risk charts often incorrectly categorize most people into the low CVD risk group due to no prior validation, leading to a higher under-treatment rate and more complications and costs to incur [31]

4. The over-simplification and absence of information on validation or discrimination index have a real effect on the sensitivity, specificity and predictive accuracy of the WHO/ISH risk charts [31]