Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study

Abstract

ObjectiveTo determine coverage of NHS Health Check, a national cardiovascular risk assessment programme in England, in the first four years after implementation, and to examine prevalence of high cardiovascular disease (CVD) risk and uptake of statins in high risk patients. MethodStudy sample was 95,571 patients in England aged 40–74years continuously registered with 509 practices in the Clinical Practice Research Datalink between April 2009 and March 2013. Multilevel logistic regression models were used to assess predictors of Health Check attendance; elevated CVD risk factors and statin prescribing among attendees. ResultsProgramme coverage was 21.4% over four years, with large variations between practices (0%–72.7%) and regions (9.4%–30.7%). Coverage was higher in older patients (adjusted odds ratio 2.88, 95% confidence interval 2.49–3.31 for patients 70–74years) and in patients with a family history of premature coronary heart disease (2.37, 2.22–2.53), but lower in Black Africans (0.75, 0.61–0.92) and Chinese (0.68, 0.47–0.96) compared with White British. Coverage was similar in patients living in deprived and affluent areas. Prevalence of high CVD risk (QRISK2≥20%) among attendees was 4.6%. One third (33.6%) of attendees at high risk were prescribed a statin after Health Checks. ConclusionsCoverage of the programme and statin prescribing in high risk individuals was low. Coverage was similar in deprived and affluent groups but lower in some ethnic minority groups, possibly widening inequalities. These findings raise a question about whether recommendations by WHO to develop CVD risk assessment programmes internationally will deliver anticipated health benefits.