Inside Health 29/3/16

the NHS Health Check programme is being implemented in the absence of direct randomised controlled trial evidence to guide it – Public Health England

BJGP editorial
BMJ OPEN January 16

BMJ review of public health policy

Inter99 –
A community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years.

n this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease.

controlled study on prevalence

In practices providing NHS Health Checks, the change in the reported prevalence of diabetes, hypertension, CHD, CKD, and AF did not differ from that of practices providing usual care.

Jeremy Hunt on twitter
Also great news that NHS HealthChecks have now saved hundreds of lives – 2500 heart attacks and strokes avoided thanks to early intervention

observational study over 2009- 2013
1.68 million people were eligible
214 295 attended (that’s 12% of those invited)

Among attendees 7844 new cases of hypertension (38/1000 Checks), 1934 new cases of type 2 diabetes (9/1000 Checks) and 807 new cases of chronic kidney disease (4/1000 Checks) were identified. Of the 27 624 people found to be at high CVD risk (20% or more 10-year risk) when attending an NHS Health Check, 19.3% (5325) were newly prescribed statins and 8.8% (2438) were newly prescribed antihypertensive therapy.

lead time bias – do slighltly earlier than would have happened anyway no effect on outcomes
people who didn’t attend were more likely to be smokers
may have been coded in GP surgery as health check as funded for such even when normal practice

aiming to invite 3 million people at an annual cost of £165 million not cost effective no matter what
unable to distinguish NHS Health Checks conducted in general practice from those conducted by a third party such as a community pharmacy

New recurrent prescriptions for statins (two or more prescriptions within 12 months) were provided for 5.1% (10 900) of attendees and new recurrent prescriptions for antihypertensives for 3.9% (8497) of attendees. Equivalently 1 in 20 attendances resulted in recurrent statin prescriptions, and 1 in 25 attendances resulted in recurrent antihypertensive prescriptions.

statin treatment rate of only 19% in high-risk attendees

Assuming that 1.2 million people attended a NHS Check each year in the 5 years since 2010, of whom 10% (120 000) were at high CVD risk averaging 2.5% per year, and 19.3% (23 160) of these people were treated with statins over this period and 8.8% (10 560) were treated with antihypertensives; if each treatment reduces cardiovascular risk by 20%, it is estimated that 2529 people would avoid a major CVD event over a 5-year period.11 ,12

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