title: Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Study 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.
  
  
  RESULTS
  Programme 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.
  
  
  CONCLUSIONS
  Coverage 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.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK. Electronic address: chu-mei.chang@imperial.ac.uk.
authors.forename: Kiara Chu-Mei
authors.initials: KC
authors.lastname: Chang
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Soljak
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK.
authors.forename: John Tayu
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Woringer
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London W2 1PG, UK.
authors.forename: Desmond
authors.initials: D
authors.lastname: Johnston
authors.affiliation: Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester LE5 4PW, UK.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control; D066264:Datasets as Topic; D019468:Disease Management; D004739:England / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015397:Program Evaluation; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D013222:State Medicine / Q000592:standards
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular disease; Primary prevention; Risk assessment; Screening