GPs have expressed concerns about Public Health England’s latest campaign, after they found that it tells anyone over 30 to go to their GP if their cholesterol level or blood pressure is unknown.
PHE launched its new heart age campaign this week, which asks members of the public over 30 to take an online test to find out their ‘heart age’ and their risk of suffering a heart attack or stroke.
But NICE has previously rejected the use of lifetime risk scores – such as the one this test is based on – due to a lack of evidence.
Doctors have questioned the advice and the campaigns potential impact on their workload, but PHE said that it does ‘not anticipate’ the campaign, due to run until 30 September, will drive ‘high volumes of people’ to their GP.
The test involves a number of physical and lifestyle questions and provides an immediate estimation of the person’s heart age, as well as a prediction of their risk of having a heart attack or stroke by a certain age.
However, if they do not know their blood pressure or cholesterol level when completing the quiz, it tells them they need to get tested and should make an appointment with their GP, nurse or pharmacist.
This has raised alarm bells for GPs and clinicians who are worried that general practice is going to see an influx of patients without risk factors.
Kent GP and LMC chair Dr Gaurav Gupta said: ‘Blanket guidance like this, without taking into account people’s other risk factors, can actually cause more harm to other parts of the population who will not be able to access GPs who are busy doing these unnecessary appointments.
‘This might cause patients to become more anxious and feel obliged to make an appointment because this test is telling them to. There is the potential that GPs will end up spending their time doing tests which are not clinically necessary, instead of looking after patients that need our help.’
Dr Margaret McCartney, a GP in Glasgow, said she had taken the test posing as a 30-year-old with no risk factors and was told to go and get both her cholesterol and blood pressure tested.
She told Pulse: ‘It is deeply concerning that the information provided by this health check for under 40 year olds does not match the information given by the NHS elsewhere. This should not be difficult to sort out and basic user testing would have avoided this confusion.’
Oxford University’s senior clinical research fellow Dr Ben Goldacre, who has just been appointed as chair of the Government’s new health technology advisory board, said: ‘The heart age tool was a nice idea, a fun gimmick, but it was poorly executed.
‘The risk coefficients are all correct: the mistake was to turn those numbers into automated health advice. Telling everyone in their 30s to ask their GP for a cholesterol test is just silly. There are 8.7m people in their 30s in the UK: this would be a huge, sudden waste of GP time and NHS resource.’
But PHE’s national lead for cardiovascular disease prevention Professor Jamie Waterall told Pulse: ‘We do not anticipate driving high volumes of people into NHS services.
‘The heart age test is an online tool, not a medical or clinical diagnostic tool, which lets adults know and understand their heart age and suggests lifestyle changes that can be made to make a difference to their health now and in the future.’
GP Dr Matt Kearney, NHS England and PHE national clinical director for cardiovascular disease prevention, added: ‘Directing people to the heart age test, with its advice and resources to support important lifestyle changes, reduces the need for time-consuming prevention discussions with the clinician.’
According to PHE, the test – which was first trialled in 2014 – has so far been taken more than 1.9m times and four out of five of people have had a heart age higher than their actual age.
But concerns have previously been raised about lifetime risk scores, with NICE rejecting their use when it updated its lipid modification guidance, citing a lack of evidence and methodology issues.
In response Professor Waterall said the tool is based on Joint British Societies guidelines and was developed in partnership with JBS3, British Heart Foundation, NHS Choices and University College London.
He said: ‘The tool uses the widely respected and validated JBS3 calculator that incorporates lifetime risk in addition to 10-year risk.’
Dr Kearney continued: ‘The long-term plan for the NHS will prioritise saving lives through improved protection against cardiovascular disease, and increased public understanding of the risks of stroke and heart disease will mean fewer people have to face these devastating conditions.’
It comes as PHE announced yesterday at NHS England’s Health and Care Innovation Expo that prevention of CVD should be one of three top priorities in the new NHS long-term plan, along with smoking and obesity.
PHE said the plan could save 250 to 500 lives each year across England by prioritising the identification of people who are at risk of developing CVD.
BMA GP Committee chair Dr Richard Vautrey said: ‘Improving a population’s heart health requires public health initiatives to encourage healthy eating, regular exercise and a change of lifestyle, including help to quit smoking and reduce alcohol intake.
‘However, with these services stretched, it is GPs and their staff, as the first point of contact for many patients, who bear the workload brunt when their local area’s health suffers.’
Dear @PHE_uk I just entered this as a 30 y old with no risk factors and it told me to get cholesterol and BP tested. What work would you like primary care to stop to do this, and where is evidence of benefit ? pic.twitter.com/2FUngHkJpE
— Margaret McCartney (@mgtmccartney) September 4, 2018
To re-iterate this thread. There are 8.7 million people in the UK in their 30s. This PHE “heart age” tool seems to be incorrectly telling them ALL to go to their GP to get their cholesterol checked. If only one in 100 do so, that’s 87,000 pointless GP consultations. Expensive.
— ben goldacre (@bengoldacre) September 5, 2018
Unfortunately this tool tells every 30 year old (with absolutely no cardiovascular risk factors) who uses it to see their GP for a cholesterol check.
What work would you like GPs to forgo to do this pointless testing of the worried well? https://t.co/OhIuD45Ac0
— Rachel Clarke (@doctor_oxford) September 5, 2018