• The authors and sponsors of the ASSIGN (v 2.0) score disclaim responsibility for misuse or abuse in clinical practice. It should be used as a guide to preventive treatment in identifying patients apparently at high risk. Data entered should be checked for plausibility and accuracy. There is no guarantee that any patient for whom the ASSIGN score is calculated either will, or will not, develop cardiovascular disease within ten years. The score is a risk estimator not an absolute predictor. The score should be used within the context of relevant guidelines on management of cardiovascular risk and is not a replacement for clinical judgement and treatment.

 

• Cohort limitations The SHHEC cohort used in the initial ASSIGN development included individuals aged 30-74 at time of recruitment. For the recalibration process the study population used were aged 40-69. Estimating risk beyond these values therefore involves a degree of extrapolation and the resulting score should be interpreted with caution. Additionally, users should acknowledge that increasing age is the dominant risk factor. Neither UK Biobank nor Generation Scotland Scottish Family Health study used in the recalibration process are entirely nationally representative. However, we are aware of no such contemporary Scottish cohort of the required size.

 

• Limitations of the calculator This calculator does not include the effect of other recognised cardiovascular disease risk factors such as atrial fibrillation (AF), obesity, chronic kidney disease and ethnicity. Therefore, the calculated score may not reliably estimate risk for certain individuals. If the person has AF for example, then an appropriate and validated risk assessment should be performed to inform optimal risk reduction relating to the presence of AF and any concomitant individual factors.

 

• If the person's ethnicity confers higher risk you may wish to compare their ASSIGN score with that from a CVD calculator that has the option to enter specific ethnicity.( keep ?)

 

• The definition of family history for the purposes of the calculator is for parents and siblings with CHD or stroke below the age of 60 – it should be noted that the family history questionnaire answered by the cohorts used in the recalibration process did not specify the age of first-degree relatives affected by cardiovascular disease (defined as heart disease and stroke).

 

• The ASSIGN (2.0) calculator has not been developed to specifically calculate risk in cases such as ex-smokers, treated hypertension and treated cholesterol.(check)

 

• Whilst the calculator accepts inputs of systolic blood pressure up to 250mmHg. It is imperative that in cases of elevated blood pressure readings, clinicians follow guidelines for treatment and onward referral as appropriate. Such as https://www.nice.org.uk/guidance/ng136/chapter/recommendations#assessing-cardiovascular-risk-and-target-organ-damage

 

• The risk factor means to substitute for missing values are based on historical population values in The Scottish Health survey and calculating provisional scores using these should be interpreted with caution.

 

• For simplicity, extreme and out of range values are the same for different age and sex groups. In clinical settings, extreme and out of range values for the person should be confirmed and managed appropriately from a clinical and patient safety perspective as a priority. Using extreme values involves extrapolation and results should be interpreted with caution.