How well did England's midlife heart-risk check work at first?
In its first four years England's NHS Health Check reached a growing but still small share of eligible adults, found many new cases of high blood pressure, and started statins in only about a fifth of the high-risk people it identified.
Source
The NHS Health Check in England: an evaluation of the first 4 years
Study at a glance
- Design
- Cohort — Descriptive retrospective analysis of the QResearch primary-care database (655 practices) covering April 2009 to March 2013; no formal attendee vs non-attendee comparison.
- N
- N=1679024 · 1 679 024 eligible adults aged 40-74; 214 295 of them attended a Health Check and form the denominator for most outcome figures.
- Population
- Adults aged 40-74 in English general practices without existing cardiovascular disease, diabetes, CKD or statin treatment.
- Outcome
- Coverage (attendance), recorded cardiovascular risk, new diagnoses of hypertension, diabetes and CKD, and new statin/antihypertensive prescribing and behavioural referrals within 12 months.
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
Researchers analysed anonymised electronic records from 655 general practices in the QResearch database. They identified all adults aged 40-74 eligible for the NHS Health Check between 2009 and 2013 and described who attended, their recorded cardiovascular risk, and what new diagnoses, prescriptions and referrals followed within 12 months. Non-attendees were described but not formally compared, because their records were incomplete.
What they found
About 12.8% of eligible people had a Health Check over the period, with yearly coverage rising from 5.8% to 30.1%. Attendance was higher in older people and was not lower in the most deprived groups. Among attendees, 12.9% were at high cardiovascular risk; checks led to one new hypertension diagnosis per 27 checks, one diabetes diagnosis per 110 and one CKD diagnosis per 265. Only 19.3% of high-risk attendees started regular statins, and most behavioural referrals went to people at lower risk.
The limits
What it doesn't show
The study is descriptive: it did not compare attendees with non-attendees or measure changes in risk factors or actual heart attacks and strokes, so it cannot show that the programme prevents cardiovascular disease. The authors' estimate of events avoided is a projection built on trial-based assumptions, not an observed result. Checks done outside general practice could not be identified, missing ethnicity data limit the ethnic comparisons, and several authors developed the QRisk score used in the programme.
Key terms
- NHS Health Check
- A national English programme offering adults aged 40-74 without known vascular disease a structured assessment of cardiovascular risk, with advice and treatment.
- QRisk2
- A UK algorithm that estimates a person's 10-year risk of heart attack or stroke from age, sex, ethnicity, deprivation, blood pressure, cholesterol and other factors.
- Coverage vs uptake
- Coverage is attendance as a share of everyone eligible; uptake is attendance as a share of those actually invited, so uptake figures are usually higher.
- High cardiovascular risk
- In this study, a 10-year predicted risk of cardiovascular disease of 20% or more, the threshold then used for recommending statins.
- Townsend deprivation score
- An area-level measure of material deprivation based on census data such as overcrowding and car ownership, used here in fifths from least to most deprived.
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Quiz yourself
What did this study primarily describe?
Common questions
Did the NHS Health Check reduce heart attacks and strokes?
This study cannot say. It only describes attendance, risk recording, new diagnoses and prescribing. The authors estimate events avoided using assumptions from drug trials, but no cardiovascular events were measured.
Why didn't the authors compare attendees with people who didn't attend?
Non-attendees had far less complete records and a different risk profile (they were younger and more likely to smoke), so any comparison would be biased.
Was the programme reaching disadvantaged groups?
Attendance was slightly higher in the most deprived fifth than in the least deprived, and was higher among older adults, so there was no evidence that these groups were being missed, though overall coverage was low.
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