NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

Abstract

BackgroundThe global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD) risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services.MethodsRandomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support) patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking.ResultsAverage population CVD risk decreased from 32.9% to 29.4% (p <0.001) in the NHS Health Check only group and from 31.9% to 29.2% (p <0.001) in the NHS Health Check plus additional lifestyle support group. There was no significant difference between the two groups at either measurement point. Prevalence of high blood pressure, high cholesterol and smoking were reduced significantly (p <0.01) in both groups. Prevalence of central obesity was reduced significantly (p <0.01) in the group receiving additional lifestyle support but not in the NHS Health Check only group.ConclusionsThe NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.

Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis

“…Our findings are also consistent with 2 previous evaluations of local Health Check programs in England, which showed significant reductions in modelled cardiovascular risk and individual risk factors (except for BMI) at 1 year after the intervention among those who attended a Health Check. 15,16 Our findings raise a question about the potential contribution of risk assessment and management programs to achieving international targets for cardiovascular mortality reduction, especially in low-resource settings and in countries where similar programs have not been deployed. The performance of the Health Check program has fallen well short of national and international performance targets for cardiovascular risk assessment programs.…”

“…[10][11][12][13] Previous assessments have been limited to evaluations of local programs, have had only short follow-up and have not taken underlying trends in cardiovascular risk into account, although some of these analyses have identified significant but modest reductions in modelled risk for cardiovascular disease and individual risk factors. [14][15][16] Evaluation of cardiovascular risk assessment programs delivered in routine care settings internationally are sparse. The impact of the Health Check program, which is being delivered in the context of a universal health system with well-developed primary care and high penetration of electronic medical records, has international significance.…”

The impact of NHS Health Checks on the prevalence of disease in general practices: a controlled study

“…Previous researchers have assessed some other aspects of the NHS Health Check scheme such as the impact on cardiovascular risk reduction 10,11 and the variation in implementation of the programme and uptake among GP practices. 12,13 There is little available research, however, evaluating the effect of NHS Health Checks on particular conditions, although one study did note that the programme failed to identify one-third of people at high risk of developing diabetes.…”

Understanding and Improving Modifiable Cardiovascular Risks within the Air Force

“…Different efforts have been made to improve cardiovascular risks, including the use of community health workers (Krantz, Coronel, Whitley, Dale, Yost & Estacio, 2013), tailored lifestyle support (Cochrane et al, 2012), community outreach (Nguyen et al, 2012), and low-dose (one day per week) physical activity (Hamer & Stamatakis, 2012). All of these interventions, except the use of community health workers, have demonstrated some positive impact on cardiovascular risks (Krantz et al, 2013;Cochrane et al, 2012;Nguyen et al, 2012;Hamer & Stamatakis, 2012). In the military population, cardiovascular risks have modestly improved through physical activity interventions in multiple countries, including Iran (Naghii, Almadadi & Zarchi, 2011), Finland (Cederberg et al, 2011), and among National Guard members in the United States (Talbot, Metter, Morrell, Frick, Weinstein & Fleg, 2011).…”