NHS Health Checks 'prevented thousands of heart atta...

"NHS Health Checks scheme hailed as 'remarkable success'," Pulse magazine reports, while The Sun adds "GP quiz [is a] life saver".

NHS Health Checks, introduced in 2009, are offered to people aged 40 to 74 years old. They look for risk factors associated with a number of related conditions: heart disease, stroke, type 2 diabetes, kidney disease and some types of dementia.

The researchers looked at how many people took part in the programme. While the uptake was initially relatively low (5.8%), this increased to about a third of those eligible in 2012-13.

It is also encouraging that some of the more vulnerable groups – those who are older and those in the most deprived social group – were most likely to attend the checks.

A proportion of those identified as being at high risk of heart disease in the checks started statins (19.3%) or high blood pressure treatment (8.8%). Extrapolating this data, the researchers estimated that NHS Health Checks prevented around 2,500 cases of major cardiovascular events such as stroke and heart attack over the course of five years.

However, there are inherent limitations to what the study can tell us. For example, it was not possible to directly assess whether all new prescriptions, treatments and lifestyle changes after the checks were as a direct result of the checks.

Overall, the study gives us a useful insight into the progress of the NHS Health Checks programme. Further research is likely to be needed to help give an indication of what impact it is having on people's risk factors and outcomes, especially as this is the first programme of its kind in the world.

Where did the story come from?

The study was carried out by researchers from Queen Mary University of London, The University of Edinburgh, and The University of Nottingham. It was independent research commissioned and funded by the Department of Health Policy Research Programme.

The study was published in the peer-reviewed medical journal BMJ Open, and is open access – meaning you can read it for free online.

The Sun briefly covered this research (only in the print edition, not online), and focused on the strokes, heart attacks, and deaths avoided. However, this was not the main focus of the study – such outcomes were only estimated in the discussion in the research paper.

The paper focused on how many people had taken part in the Health Check programme, their characteristics, and what the checks identified. The Sun did not make clear that the numbers they reported were only estimates of the major heart and vascular disease events avoided, not actual numbers. The study does not give estimates on the possible number of deaths avoided.

Pulse, the specialist magazine aimed at GPs, provided balanced quotes from supporters and critics of the programme.

What kind of research was this?

This was an observational study aiming to describe the uptake of and findings from the NHS Health Check programme, which aims to reduce the burden of cardiovascular diseases.

The NHS Health Check programme is offered nationally to people aged 40 to 74 years old. It aims to invite those eligible once every five years.

The check involves assessment of an individual's cardiovascular risk factors – such as their blood pressure and blood glucose and cholesterol levels. It also offers advice to support individuals to make health changes in their lives (such as stopping smoking or reducing alcohol consumption), and offers treatment to those identified as being at high risk of heart disease or as having conditions such as diabetes. People already known to have heart disease or conditions associated with an increased risk of heart disease, such as high blood pressure, or are already taking statins are not eligible for the check.

What did the research involve?

The researchers analysed data on the NHS Health Check programme over four years since it started in 2009. They got this data from a large electronic database that routinely collects data from 655 GP practices, and has records for 13 million patients.

Using this data, the researchers:

assessed how many of those eligible for the checks attended
compared the characteristics of those who attended with those who did not attend
looked at how many people who attended the checks were identified as being at high risk of heart disease (defined as having at least a 20% chance of developing heart disease over the next 10 years) or having specific conditions, such as type 2 diabetes
identified how many people were referred for further assessments or given new treatment in the year after attending the checks, and compared this with those not attending

The researchers were not able to carry out statistical comparisons between people attending the checks and those not attending, as they did not have enough data on the non-attendees.

What were the basic results?

The researchers found that about 13% (214,295 people) of the 1.68 million people eligible to have the NHS Health Check in the four years studied attended a Health Check. The proportion of people taking up the Health Check increased from 5.8% in 2010 to 30.1% in 2012.

People were more likely to attend the check if they were older or from socially disadvantaged groups (who are at higher heart disease risk). About a fifth (19.6%) of those aged 60 to 74 years old attended the check compared to 9.0% of those aged 40 to 59 years old.

Among the most socially disadvantaged group 14.9% attended, compared with 12.3% among the least socially disadvantaged group. Attendance was highest among individuals of black Caribbean ethnicity (19.6%) and South Asian ethnicity (19.2%), and lowest among individuals of black African ethnicity (15.7%) and Chinese ethnicity (15.3%).

Individuals who attended the checks were more likely to have information such as their alcohol consumption recorded (95.9%) compared with those who did not attend (80.3%).

During the study period, the checks identified:

7,844 new cases of high blood pressure (1 new case in every 27 checks)
1,934 new cases of type 2 diabetes (1 new case in every 110 checks)
807 new cases of chronic kidney disease (1 new case in every 265 checks)
27,624 people (12.9% of all attendees) as being at high risk of heart disease

In the year after the check, those who attended were more likely to have a new condition such as high blood pressure recorded than those who did not attend. However, a lot of the non-attendees had missing data, making it difficult to carry out comparisons.

During the check, more than one in five of the participants had a risk factor identified that needed further follow-up. In the year after the check, about a fifth (19.3%) of the people who were identified as being at high risk were started on statins, and 8.8% were started on blood pressure medication.

The researchers estimated that at this rate of new statin and high blood pressure treatments, 2,529 people could avoid a major heart or vascular disease event over five years if 1.2 million people attended the Health Checks each year (assuming treatments reduce risk by 20%). The 1.2 million people seems to be based on applying the attendance rate seen in the study sample to the whole eligible population. The researchers suggest this could be a low estimate, as it does not take account of the fact that people may also change their behaviour as a result of the check and referrals.

How did the researchers interpret the results?

The researchers concluded that their study "indicates limited though improving success in the early years of a major new national preventive programme". They say that "this modest start to a major new programme at scale is likely to have made an important impact on CVD [cardiovascular diseases] events in people who have been treated with statins and [high blood pressure medication] or who improved adverse risk factors".

Conclusion

This descriptive study has provided information about how many people took part in the NHS Health Check programme in the first four years it was available.

While the uptake was initially relatively low, it is increasing. It is also encouraging that some of the more vulnerable groups – those who are older and those in the most deprived social group – are most likely to attend the checks.

There were limitations to the data available. For example, it was not possible to directly assess whether all new prescriptions and treatments after the checks were as a direct result of the checks. The proportion of people who took part in lifestyle change programmes as advised is also not known.

The study did not assess changes in the risk factors or outcomes of the individuals who had or did not have the Health Checks. The researchers note that it is difficult to make these comparisons in a non-randomised study, or where the data is incomplete (such as health information for those who did not attend the checks). They did calculate an estimate of major heart and vascular events that might be avoided as a result of the Health Checks over five years, under certain assumptions. However, this is a rough estimate to give some idea of possible impact, and may not be fully representative of true effects.

The authors noted that other studies, such as a review of 16 trials, have challenged the effectiveness of the Health Check. For example, a study we discussed in November 2014 questioned whether Health Checks were making a significant difference in reducing the prevalence of chronic diseases such as diabetes.

However, they point out that most of the studies (12 out of 16) included in that review were carried out more than 20 years ago, when modern statins and high blood pressure medications were not in use.

Overall, the study gives a picture of the progress of the NHS Health Checks programme since its launch in 2009. It is important that this type of programme is monitored to see how many people are taking part and what effect it is having. More research is needed to help give an indication of what impact it is having on people's risk factors and outcomes.

You can get an NHS Health Check if you're aged 40 to 74 and not already known to have existing cardiovascular disease or a condition that is a risk factor for cardiovascular disease. If you fall into this category, you can expect to receive a letter inviting you for a check.

Don't worry if you haven't got your invitation yet, as you will be invited for one over the next few years.

Read more about how you can get a NHS Health Check.