Implementation matters: clinical consequences of applying SCORE2 as a chart or with the underlying algorithm

This editorial refers to ‘SCORE2 charts assign a different risk category than the underlying model in a large portion of Polish primary care patients’, by M. Goławski et al., https://doi.org/10.1093/eurjpc/zwaf555. The European Society of Cardiology (ESC) cardiovascular prevention guidelines advocate for the use of risk prediction models to support and improve healthcare and population-wide prevention strategies.1 In the 2021 ESC cardiovascular disease (CVD) prevention guidelines, the SCORE2 and SCORE2-OP models became the recommended models in Europe to identify individuals at high risk of CVD.1–3 These models are widely used to identify high-risk individuals, signalling them for possible preventive actions. To support their use in clinical practice, the original SCORE2 and SCORE2-OP publications included two-dimensional risk charts, which were subsequently redrawn as a single combined chart in the 2021 guidelines.1–3 These charts provide a convenient tool for busy clinicians, allowing quick estimation of 10-year CVD risk at the point of care. On top of this, both models have been made available through online calculators (ESC CVD risk prediction app and www.U-Prevent.com), which are both also explicitly named in the guidelines. These online calculators directly apply the underlying SCORE2/SCORE2-OP algorithms as were published. While the online tools use the original continuous models, the paper charts inevitably involve simplification: predictors are rounded to predefined categories, and HDL-cholesterol and total cholesterol must be combined into non-HDL-cholesterol.