Cardiovascular disease (CVD) continues to be the leading cause of death in the UK and globally, despite decades of public health advances and improvements in treatment. As clinicians, our ability to accurately assess risk is central to preventing serious cardiovascular events such as myocardial infarction and stroke. Now, a new tool—QR4, developed by researchers at the University of Oxford—is poised to redefine how we identify patients most at risk.
This article explores what makes QR4 different from its predecessor, QRISK3, and how its adoption in clinical practice could transform patient care.
From QRISK3 to QR4: What’s Changed?
QRISK3 has long been a staple in UK general practice, offering a validated 10-year cardiovascular risk estimate based on routinely collected patient data. However, QR4 builds significantly on this foundation by:
| Feature | QRISK3 | QR4 |
| Data Source | 10 million+ UK patients | 16 million+ UK patients from 1,400 practices |
| Clinical Conditions | Includes 19 health conditions | Expands to 44 conditions, including rare and under-recognised risks |
| Women’s Health | Includes migraine, HRT use, severe mental illness | Adds postnatal depression, pre-eclampsia, polycystic ovary syndrome |
| Cancer Risk Links | Not directly included | Newly identifies links with oral, brain, lung, and blood cancers |
| Neurodevelopmental Disorders | Not included | Adds Down syndrome, learning disabilities |
| Predictive Accuracy | Strong but limited in some subgroups | Improved calibration, especially in ethnic minorities and people with rare conditions |