Public Policy Approaches to the Prevention of Heart Disease and Stroke

Pearson, Thomas A.

doi:10.1161/circulationaha.110.968743

Cited by 29 publications

(23 citation statements)

References 55 publications

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“…Further evaluation of cost and clinical effectiveness is needed as programme resources may be better deployed in whole population strategies, to increase physical activity, reduce smoking and encourage healthy eating, 33 for reducing Reference group in z-test, **P < 0.01 and *P < 0.05 for z-test. cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Uptake of the NHS Health Check programme in an urban setting

et al. 2013

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Background. The NHS Health Check programme aims to improve prevention, early diagnosis and management of cardiovascular disease (CVD) in England. High and equitable uptake is essential for the programme to effectively reduce the CVD burden. Objectives. Assessing the impact of a local financial incentive scheme on uptake and statin prescribing in the first 2 years of the programme.Methods. Cross-sectional study using data from electronic medical records of general practices in Hammersmith and Fulham, London on all patients aged 40-74 years. We assessed uptake of complete Health Check, exclusion of patients from the programme (exception reporting) and statin prescriptions in patients confirmed with high CVD risk.Results. The Health Check uptake was 32.7% in Year 1 and 20.0% in Year 2. Older patients had higher uptake of Health Check than younger (65-to 74-year-old patients: Year 1 adjusted odds ratio (AOR) 2.05 (1.67-2.52) & Year 2 AOR 2.79 (2.49-3.12) compared with 40-to 54-year-old patients). The percentage of confirmed high risk patients prescribed a statin was 17.7% before and 52.9% after the programme. There was a marked variation in Health Check uptake, exception reporting and statin prescribing between practices.Conclusions. Uptake of the Health Check was low in the first year in patients with estimated high risk despite financial incentives to general practices; although this matched the national required rate in second year. Further evaluations for cost and clinical effectiveness of the programme are needed to clarify whether this spending is appropriate, and to assess the impact of financial incentives on programme performance.

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Section: Discussionmentioning

confidence: 99%

Uptake of the NHS Health Check programme in an urban setting

et al. 2013

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“…117 The high-risk approach seeks to identify and treat intensively only those individuals with the highest levels of cholesterol, whereas the population approach reduces overall risk by reducing cholesterol levels in the entire population ( Figure 7). 118 Concerted efforts between governmental agencies, communities, and the private sector are required to address the continuing CVD epidemic. 119 A wealth of clinical trials included in many of the large and sophisticated meta-analyses discussed above [98][99][100][101][102][103] have documented the efficacy of interventions both in primary and secondary prevention.…”

Section: Epidemiology and Cvd Preventionmentioning

confidence: 99%

Epidemiological studies of CHD and the evolution of preventive cardiology

2014

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Cardiovascular diseases (CVDs) cause nearly one-third of all deaths worldwide. Coronary heart disease (CHD) accounts for the greatest proportion of CVDs, and risk factors such as hypertension, cigarette smoking, diabetes mellitus or elevated glucose level, elevated cholesterol levels, and obesity or being overweight are the top six causes of death globally. Ecological and population-based longitudinal studies, conducted globally or within individual countries, have established the role of traditional and novel risk factors and measures of subclinical disease in the prediction of CHD. Risk assessment with short-term or long-term risk prediction algorithms can help to identify individuals who would benefit most from risk-factor interventions. Evaluation of novel risk factors and screening for subclinical atherosclerosis can also help to identify individuals at highest cardiovascular risk. Prevention of CHD focuses on identifying and managing risk factors at both the population and individual levels through primordial, primary, and secondary prevention. Epidemiological studies have provided the hypotheses for subsequent clinical trials that have documented the efficacy of risk-factor interventions, which are the basis of preventive cardiology. Future research efforts will determine the screening and intervention strategies that have the greatest effect on CHD prevention.

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“…An earlier report in this series, "Public Policy Approaches to the Prevention of Heart Disease and Stroke," outlines clearly and concisely just such a process of translation. 48 The view that CVD-related and, more broadly, NCDrelated activities should become closely aligned with successes in HIV/AIDS, at least in the setting of long-term case management, expands the frame of thinking even further. CVD is less clearly visible in this new context than formerly.…”

Section: Discussionmentioning

confidence: 99%