Evaluation of a National Cardiovascular Risk Assessment Programme (NHS Health Check)

Abstract

Background: The NHS Health Check, the largest systematic cardiovascular disease (CVD) primary prevention programme globally, aims to reduce CVD burden and health inequalities by assessing and managing CVD risk among 40 to 74 year old individuals without existing vascular diseases. I evaluated the impact of the programme at local and national levels. Methods: Using electronic medical record data from general practices in Hammersmith and Fulham, I assessed CVD risk factor recording before the programme, the programme uptake in the first two years and the impact of the programme on CVD risk. National coverage of the programme in one financial year was assessed using data from Primary Care Trusts (PCTs). Results: There was good recording of smoking status (86.1%) and blood pressure (82.5%), with lower BMI (59.5%) and cholesterol (47.5%) recording among Health Check eligible patients before the programme in Hammersmith and Fulham. Uptake of the Health Check was lower than the national target (75%) at 39.2% among patients with an estimated high CVD risk, but matched the national required rate at 20.0% among all remaining eligible patients. There was significant reduction in mean global CVD risk score (28.2% to 26.2%) after one year among patients with estimated high risk that had a complete Health Check. The programme uptake was higher in patients living in more deprived areas among those not at estimated high risk (adjusted odds ratio = 0.88 (0.73-106)). Mean national coverage of the programme was lower (8.1%) than anticipated (18%), with large PCT-level variation (0% to 29.8%). Coverage was significantly greater in PCTs in more deprived areas (coefficient = -0.51 (-1.88-0.00), p-value: 0.035). Conclusions: Population-wide impact of the NHS Health Check may be limited by poor uptake of the programme. This and other limitations to the programme suggest that a targeted screening approach along with population-wide strategies may be a better option for more cost-effective prevention of CVD.