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NHS Health Checks have ‘modest’ effect on reducing CVD risk

The Government’s flagship vascular screening programme for all patients aged 40 to 74 years results in ‘modest’ improvements in cardiovascular risk a year later, but take-up remains low, finds a new analysis.

Researchers found those who had an NHS Health Check had a statistically significant fall of two percentage points in their mean CVD risk.

However, the programme’s uptake was relatively low, with only 40% of the patients invited having a complete health check at the first appointment – much lower than the Government’s target of 75%.

In addition, high-risk ethnic minority groups did not achieve significant reductions in global CV risk score.

The more positive findings of the study may offer a glimmer of hope for the NHS Health Checks programme, which has come under heavy criticism from some GPs and public health experts. A recent Cochrane review concluded that such programmes are of no benefit in terms of mortality and morbidity and likely miss those most at risk of disease.

The Government recently announced the programme would be rolled out across the whole of England, despite one study showing the scheme fails to identify a third of patients at risk of diabetes.

The Imperial College London researchers followed over 4,700 patients registered at general practices in Hammersmith and Fulham PCT in West London who were invited for a health check after being identified as at high risk of CVD based on their existing medical data.

In all, 1,886 patients had a complete health check and 2,703 a partial health check in this first year. Of these, 3,712 patients – 1,574 with a complete health check at baseline – also had data available from a subsequent follow-up appointment between December 2009 and March 2011.

Among those with a complete health check at baseline, the mean global CVD risk score fell significantly from 28.2% to 26.2%.

This group also had significant reductions in diastolic blood pressure levels, which decreased from an average of 80.7 mmHg to 79.6 mmHg, total cholesterol levels, which fell from 5.26 mmol/l  to 4.98 mmol/l, and the total/HDL-cholesterol ratio, which went down from 4.44 to 4.13.

The researchers said the reduction in predicted CVD risk score may be largely due to the improvements in cholesterol levels, which corresponded with a substantial increase in statin prescriptions. The proportion of patients prescribed a statin increased from 14% to 61%.

The greatest reductions in CVD score were seen in men, younger patients, White patients and the most deprived groups. Black and South Asian patients did not have significant improvements in predicted CVD risk.

The team concluded: ‘The introduction of NHS Health Check was associated with significant but modest reductions in CVD risk among screened high-risk individuals.

‘Further cost-effectiveness analysis and work accounting for uptake is required to assess whether the programme can make significant changes to population health.’

Furthermore, the researchers wrote: ‘Many local programmes, including the one evaluated here, targeted individuals at high risk of CVD in their first year. Assessment of uptake and the relative gains of risk assessment in lower risk group are required, and must be balanced against other public health policy options.’

Prev Med 2013; available online 21 May


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