Evaluating the effectiveness of the NHS Health Check programme in South England: a quasi-randomised controlled trial

Kennedy, Oliver John; Su, Fangzhong; Pears, Robert; Walmsley, Emily; Roderick, Paul

doi:10.1136/bmjopen-2019-029420

Cited by 19 publications

(23 citation statements)

References 30 publications

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“…Like other earlier studies 2009-13, 16 29-34 our 2013-17 study identified more diagnoses of new hypertension, diabetes and chronic kidney disease and higher prescription of statins among NHS Health Check attendees. 35 Our study is the first to report increased diagnoses of atrial fibrillation and dementia resulting from an NHS Health Check. Three previous studies considered atrial fibrillation, and none reported dementia using populations comprised largely of people under age 65 years in which both conditions are rare and hence unlikely to identify changes in diagnosis.…”

Section: Comparison With Existing Literaturementioning

confidence: 71%

“…Three previous studies considered atrial fibrillation, and none reported dementia using populations comprised largely of people under age 65 years in which both conditions are rare and hence unlikely to identify changes in diagnosis. 36 35 Chang 29 found increased atrial fibrillation diagnosis in attendees, which was not significant after matching. Our study used a denominator of age 65 -74 years followed for 12 months and we observed significantly more new diagnosis of atrial fibrillation in attendees 5/1000 than non-attendees 3/1000.…”

Section: Comparison With Existing Literaturementioning

confidence: 91%

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NHS Health Checks: an observational study of equity and outcomes 2009–2017

et al. 2021

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Background: The NHS Health Check cardiovascular prevention programme is now 10 years old. Aim: We describe NHS Heath Check attendance, new diagnoses and treatment in relation to equity indicators. Design and Setting: Using a national general practice database 2009-17, we compared NHS Health Check attendance and new diagnoses and treatments, by age, gender, ethnic group and deprivation. Results: In 2013-17, 590,218 eligible people age 40-74 years attended an NHS Health Check (16.9%) and 2,902,598 (83.1%) did not attend. South Asian ethnic groups were most likely to attend and women more than men. New diagnoses were more likely in attendees than non-attendees; hypertension 25/1000 attendees vs 9/1000 in non-attendees; type 2 diabetes 8/1000 vs 3/1000; chronic kidney disease 7/1000 vs 4/1000. In people aged 65 or older, new atrial fibrillation was diagnosed in 5/1000 attendees and 3/1000 non-attendees and for dementia 2/1000 versus 1/1000 respectively. Type 2 diabetes, hypertension and CKD were more likely in more deprived groups, South Asian and black African/Caribbean ethnic groups. Attendees were more likely to be prescribed statins, 26/1000, than non-attendees 8/1000; and anti-hypertensive medicines, 25/1000 vs 13/1000 non-attendees. However, of the 117,963 people with 10% or greater CVD risk eligible for statins only 9,785 (8.3%) were prescribed them. Conclusions: NHS Health Checks uptake remains low. Attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension and CKD and receive treatment with statins and antihypertensives. Most attendees received neither treatment nor referral. Of those eligible for statins, fewer than 10% were treated.

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Section: Comparison With Existing Literaturementioning

confidence: 71%

Section: Comparison With Existing Literaturementioning

confidence: 91%

NHS Health Checks: an observational study of equity and outcomes 2009–2017

et al. 2021

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“…In 11 studies, 21,23,26,[30][31][32]34,[37][38][39][40] 7 of which were trials, general health checks were associated with small or moderate improvements in measures such as blood pressure, cholesterol, and cardiovascular risk scores. In the Family Heart Study conducted in the U.K. (n=12,924), both women and men randomized to a general health check followed by tailored follow-up had reduced systolic blood pressure (6.4 mmHg reduction for women; 7.4 mmHg for men) and diastolic blood pressure (2.7 mmHg for women; 3.3 mmHg for men) after one year.…”

Section: Risk Factor Controlmentioning

confidence: 99%

“…In four randomized trials 19,24,30,31 and six observational studies, 32-37 detection of chronic disease was increased among patients receiving general health checks. In the recent Check-In Study trial among patients aged 45 to 64 with low levels of education, 5% of patients randomized to a single preventive health check, and 2% of those randomized to usual care, received a new antidepressant prescription over one year.…”

Section: Observationsmentioning

confidence: 99%

General Health Checks in Adult Primary Care: A Review

Liss¹,

Uchida²,

Wilkes

et al. 2021

Preprint

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Importance: General health checks (also known as general medical exams, periodic health evaluations, checkups, or wellness visits) to identify and prevent disease are extremely common in adult primary care. Although general health checks are often expected and advocated by patients, clinicians, payers, and health systems, others question their value. The current evidence was updated and recommendations provided for conducting general health checks in adults. Observations: Randomized trials and observational studies with control groups from prior systematic reviews and an updated literature review through December 2020 were included. Out of 19 included randomized trials (906 to 59,616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check and 7 evaluated annual health checks. All of 12 included observational studies (240 to 471,415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, in the South-East London Screening Study (n=7,229), adults age 40 to 64 who were invited to two health checks over two years experienced no 8-year mortality benefit (6% overall). However, general health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as quality of life and self-rated health. General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. For example, in the OXCHECK trial (n=4121), fewer intervention participants exercised less than once per month (68% versus 71%). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advanced directives. Conclusions and Relevance: General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment; risk factor control, preventive service uptake, and patient-reported outcomes. Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection to primary care.

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“…More common in men M ore common in women Symptom prevalence: Both men and women with confirmed ACS presented most often with chest pain (pooled prevalence men 79% [72-85]; women 74% [67][68][69][70][71][72][73][74][75][76][77][78][79][80][81]), diaphoresis (men 47% [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]; women 44% [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]), shortness of breath (men 40% [35][36][37]…”

Section: Chest Painmentioning

confidence: 99%

Detection of cardiovascular disease and cardiovascular risk factors in a changing world

Boer¹

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Chapter 1General introduction Examples of a changing cardiovascular landscapeChapter 2 Heart failure types across health care settings in women and men Chapter 3Atrial fibrillation: Trends in prevalence and antithrombotic prescriptions in the community Detection and recognition of cardiovascular disease Chapter 4Screening for abdominal aortic aneurysm in patients with clinically manifest vascular disease Chapter 5Sex differences in symptom presentation in acute coronary syndromes: a systematic review and meta-analysis Chapter 6Primary health care contact before referral for acute coronary syndrome Cardiovascular risk factor measurement Chapter 7Improving participation in screening for cardiovascular risk: a short report Chapter 8Blood pressure and cholesterol measurements in primary care: cross-sectional analyses in a dynamic cohort (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) Chapter 9Cardiovascular risk management after hypertensive disorders of pregnancy: a cohort study using electronic health record data Chapter 10Datamining to retrieve smoking status from electronic health records in primary care Chapter 11General discussion

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Evaluating the effectiveness of the NHS Health Check programme in South England: a quasi-randomised controlled trial

Cited by 19 publications

References 30 publications

NHS Health Checks: an observational study of equity and outcomes 2009–2017

NHS Health Checks: an observational study of equity and outcomes 2009–2017

General Health Checks in Adult Primary Care: A Review

Detection of cardiovascular disease and cardiovascular risk factors in a changing world

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