title: Protocol for the 'e-Nudge trial': a randomised controlled trial of electronic feedback to reduce the cardiovascular risk of individuals in general practice [ISRCTN64828380].
abstract: BACKGROUND
  Cardiovascular disease (including coronary heart disease and stroke) is a major cause of death and disability in the United Kingdom, and is to a large extent preventable, by lifestyle modification and drug therapy. The recent standardisation of electronic codes for cardiovascular risk variables through the United Kingdom's new General Practice contract provides an opportunity for the application of risk algorithms to identify high risk individuals. This randomised controlled trial will test the benefits of an automated system of alert messages and practice searches to identify those at highest risk of cardiovascular disease in primary care databases.
  
  
  METHODS
  Patients over 50 years old in practice databases will be randomised to the intervention group that will receive the alert messages and searches, and a control group who will continue to receive usual care. In addition to those at high estimated risk, potentially high risk patients will be identified who have insufficient data to allow a risk estimate to be made. Further groups identified will be those with possible undiagnosed diabetes, based either on elevated past recorded blood glucose measurements, or an absence of recent blood glucose measurement in those with established cardiovascular disease.
  
  
  METHODS
  The intervention will be applied for two years, and outcome data will be collected for a further year. The primary outcome measure will be the annual rate of cardiovascular events in the intervention and control arms of the study. Secondary measures include the proportion of patients at high estimated cardiovascular risk, the proportion of patients with missing data for a risk estimate, and the proportion with undefined diabetes status at the end of the trial.
authors.affiliation: Health Services Research Institute, Warwick Medical School, Gibbet Hill Rd, Coventry CV4 7AL, UK. tim.holt@warwick.ac.uk
authors.forename: Tim A
authors.initials: TA
authors.lastname: Holt
authors.forename: Margaret
authors.initials: M
authors.lastname: Thorogood
authors.forename: Frances
authors.initials: F
authors.lastname: Griffiths
authors.forename: Stephen
authors.initials: S
authors.lastname: Munday