Evaluation of the NHS Health Check Programme; Local and National Findings from the Early Stages of the Programme

Abstract

Background: The NHS Health Check programme is one of the boldest commitments to primary prevention in cardiovascular disease (CVD) internationally. It offers risk assessment and management to the entire 40 to 74 year old population, without existing vascular disease. I aim to assess its early impact in general practice, and examine workload implications. Methods: Modelling the population at high risk of CVD in England; comparing CVD risk prediction using two risk scores, and two methods of data imputation for missing risk factor data; the assessment of CVD risk factor recording before the programme and Health Check uptake, using patient-level medical record data from general practice in Ealing, London. Results: Prior to the programme, in Ealing, there was good recording of blood pressure (85.6%) and smoking status (95.8%) in a general population; cholesterol recording was lower (55.6%). Uptake of the Health Check was lower than national estimates at 45% compared with 75% projections, and there were small increases in statin prescribing, reaching 45 percent of the eligible population. Health Check uptake were greater in south Asian patients (adjusted odds ratio=1.80 (1.37-2.36). The JBS2 CVD risk score generated overall higher estimates of risk than QRISK2 (mean of 13% compared with 11%); this was significantly greater in south Asian men, the group exposed to the JBS2 risk multiplication factor. Modelling, using QRISK2, predicts 2 million patients at high risk in England, with screening and management costing £176 million. Cost using the JBS2 risk score are estimated to be over two times higher JBS2 Conclusions: Poor uptake of the NHS Health Check and interventions will severely limit the population-wide impact of the programme, Given this, and other limitations, I suggest a targeted approach to screening may be an appropriate alternative, and demonstrate from previous literature the complimentary use of population-wide prevention is likely to significantly improve CVD prevention.