RT Journal Article
SR Electronic
T1 Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP cmaj.151201
DO 10.1503/cmaj.151201
A1 Kiara Chu-Mei Chang
A1 John Tayu Lee
A1 Eszter P. Vamos
A1 Michael Soljak
A1 Desmond Johnston
A1 Kamlesh Khunti
A1 Azeem Majeed
A1 Christopher Millett
YR 2016
UL http://www.cmaj.ca/content/early/2016/05/02/cmaj.151201.abstract
AB Background: The National Health Service Health Check program in England is the largest cardiovascular risk assessment and management program in the world. We assessed the effect of this program on modelled risk of cardiovascular disease, individual risk factors for cardiovascular disease, prescribing of relevant medications and diagnosis of vascular disease.Methods: We obtained retrospective electronic medical records for a randomly selected sample of 138 788 patients aged 40-74 years registered with 462 English general practices participating in the Clinical Practice Research Datalink between 2009 and 2013. We used a quasi-experimental design of difference-in-differences matching analysis to compare changes in outcomes between Health Check attendees and nonattendees, with a median follow-up time of 2 years.Results: Overall, 21.4% of the eligible population attended a Health Check. After matching (n = 29 672 in each group), attendees had a significant absolute reduction in modelled risk for cardiovascular disease (-0.21%, 95% confidence interval [CI] -0.24% to -0.19%) and individual risk factors: systolic blood pressure (-2.51 mm Hg, 95% CI -2.77 to -2.25 mm Hg), diastolic blood pressure (-1.46 mm Hg, 95% CI -1.62 to -1.29 mm Hg), body mass index (-0.27, 95% CI -0.34 to -0.20) and total cholesterol (-0.15 mmol/L, 95% CI -0.18 to -0.13 mmol/L). Statins were prescribed for 39.9% of attendees who were at high risk for cardiovascular disease. The program resulted in significantly more diagnoses of selected vascular diseases among attendees, with the largest increases for hypertension (2.99%) and type 2 diabetes mellitus (1.31%).Interpretation: The National Health Service Health Check program had statistically significant but clinically modest impacts on modelled risk for cardiovascular disease and individual risk factors, although diagnosis of vascular disease increased. Overall program performance was substantially below national and international targets, which highlights the need for careful planning, monitoring and evaluation of similar initiatives internationally.