National primary care health checks can reduce deaths from cardiovascular disease over a five-year period as a result of increased statin prescribing.
Primary care health checks may have prevented 8,400 heart attacks and strokes over five years. The UK National Health Service (NHS) Health Check Programme was launched in England and Wales in 2009. It was the first of its kind anywhere in the world. The aim was to identify risk levels for cardiovascular disease, diabetes, and stroke and in subsequent years the identification of dementia risk was added. It is offered to all patients aged 40–74 without a pre-existing condition, every five years. The annual cost of the scheme in 2015 was €522.3 million.
The check is scheduled for 20 to 30 minutes and is most often with a nurse or healthcare assistant. Within that time, patients are asked questions about their health behaviors, for example, smoking, drinking, physical activity, and diet. Biomedical measures include capillary (finger prick) cholesterol, and blood glucose, blood pressure and body mass index (BMI). Those found to have a high blood pressure reading, raised cholesterol and blood glucose are scheduled for further evaluation.
Over subsequent years the scheme attracted much controversy with researchers (Cochrane Group, Journal of Public Health), The Royal college Of General Practitioners and Politicians questioning its evidence base.
A recent observational study in both the British Medical Journal and the British Journal of General Practice has now reported that the programme may have prevented an estimated 4,600-8,400 myocardial infarctions, strokes, or deaths due to these causes over the past five years by increasing statin use. Further reductions in cardiovascular disease events may have been prevented by the diagnosis and treatment of diabetes, hypertension, and chronic kidney disease.
Researchers retrospectively analysed practice databases of comorbidities identified in 85,122 people aged 40-74 without pre-existing cardiovascular disease, hypertension, hyperlipidaemia, or diabetes who attended health checks at 139 general practices in London. They were compared with matched controls who had not attended health checks during the study period (2009-14).
Health check attendees were 30 per cent more likely to have diabetes newly diagnosed than people who did not attend, had 50 per cent higher odds of a hypertension diagnosis and had 83 per cent higher odds of having chronic kidney disease diagnosed. Fourteen percent of attendees were referred to lifestyle interventions for obesity, smoking, alcohol or blood pressure compared to just six per cent of those who were referred through standard care.
Those who attended the health checks were more likely to have their CVD risk calculated using QRISK2 than non-attendees (92 per cent v 72 per cent) The researchers suggest that this increased CVD risk assessment resulted in statins being prescribed more often to attendees with a CVD risk of ≥20 per cent than non-attendees (11.5 per cent v 8.2 per cent). Replicated nationally, it is calculated that statin use resulting from NHS Health Checks would prevent an estimated 4,600 to 8,400 myocardial infarctions, strokes, or death from these causes in five years. Such a programme could also help to identify and treat 44,000 new cases of hypertension, a year. One in 25 attendences resulted in recurrent antihypertensive prescription. It is also estimated that 10,000 new cases of diabetes and 4,500 new cases of kidney disease would be diagnosed in England every year.
Take home Message
National primary care health checks can reduce deaths from cardiovascular disease over a five-year period as a result of increased statin prescribing.They can result in an increased diagnosis of diabetes, hypertension and chronic renal disease. They result in lifestyle interventions for obesity, smoking, alcohol or blood pressure