Government mulls lifetime risk for vascular checks programme

By Lilian Anekwe

Exclusive: The Department of Health is believed to be considering the use of a lifetime risk score for its NHS Health Checks programme, potentially redrawing the way patients are assessed for cardiovascular risk in primary care.

The Government's flagship scheme offers all patients in England and Wales aged 40 to 74 an assessment of their risk of cardiovascular disease using a 10-year risk tool to calculate risk and guide advice and treatment where indicated.

But with the Joint British Societies guidance expected to reject 10-year risk estimation in favour of a new score telling patients how likely they are to suffer a cardiovascular event at various points in their lives, a source has told Pulse that the national clinical director for heart disease and member of the JBS3 committee, Professor Roger Boyle, has ‘bought in to' the concept of lifetime risk and supports communicating this to patients.

Speaking at a Westminster Health Forum event last month, Professor Boyle gave the use of lifetime risk scoring a strong endorsement.

'The challenge here is to explain risk to people and we have big plans with the Joint British Society Guidelines Review going on at the moment to have a much better way of explaining risk to people to show what it means for their lifetime chances and the notion of assessing lifetime risk as well as 10 year risk of an event I think is going to be really important.'

The Department of Health is currently updating its NHS Health Check programme handbook with best practice guidance on how to screen for cardiovascular disease.

A Department of Health spokesperson said they were watching the JBS3 guideline development 'closely': ‘We are interested in anything which helps the public make more informed decisions about lifestyle choices.'

But GP advisors to the Department of Health have warned against making any changes without first building an evidence case.

Professor Kamlesh Khunti, professor of diabetes and vascular medicine at the University of Leicester and a GP in the city who has advised the Department of Health on the health checks programme, said it was down to GPs to make sure risk is properly communicated to patients – regardless of which tool is used.

‘What's most important is that GPs communicate risk appropriately in a way that patients understand, and that's already there and fundamental to the health checks scheme. It's crucial that GPs explain the risks to patients properly and advise them on what to do to reduce or mitigate their risks.

‘That's as important as the type of risk tool that is used. There is no evidence that communicating lifetime risk is more likely to change patients' behaviour. There is a divide between GPs – some think a 10-year risk is more easily understandable, others say lifetime risk is.

'We need a trial of one compared to the other, that's the work the Department of Health should be doing.'

Pulse revealed in December that the forthcoming Joint British Societies guidance would prompt GPs to adopt a ‘culture change' in their management of cardiovascular disease by rejecting 10-year risk estimation – the basis of risk assessment for the past 35 years – in favour of lifetime risk.

But the plans have sparked fierce debate among leading experts about whether the change is merited.

• The JBS guideline group is set to recommend a new risk algorithm for the management of cardiovascular disease
• The algorithm will allow GPs to explain to patients their lifetime risk of a cardiovascular event
• Younger patients, in particular women, have a higher lifetime risk of cardiovascular events and could benefit from lifestyle advice
• The risk calculator will also include factors such as heart age, and will model the impact of lifestyle changes
• Its use in the NHS Health Check programme could mean thousands more patients would receive medical treatment

Visit Pulse's cardiovascular section for news and CPD on this issue.