Cardiovascular
How well did England's midlife heart-risk check work at first?
Open access · cc by · source: Europe PMC
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.
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.
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Key findings
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.
Methodology
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.
Limitations
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.
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