Despite cardiovascular disease killing more persons than any other illness, cancer included, and being responsible for one in four premature deaths, it may come as a surprise that only half of the population take up the offer of a completely free NHS Health Check, sometimes also referred to as a “healthy heart check”.
With many of the symptoms of heart disease, including raised cholesterol, atrial fibrillation and hypertension often asymptomatic, the NHS Health check can be thought of as a screening tool, in the same manner as that for cervical cancer. Current figures suggest that in the UK there are 5.5 million persons with undiagnosed hypertension, and over half a million with atrial fibrillation, both strong risk factors for the development of cardiovascular and cerebrovascular disease.
The current NHS Health Check is available to all persons between 40-74 years of age, who do not have pre-existing heart or kidney disorders, and without a diagnosis of diabetes. It aims to pick up those with established disease which is currently asymptomatic, as well as individuals who are at increased risk of developing these conditions. Evidence has demonstrated that if heart disease is detected at an early stage, appropriate treatment can be instituted to slow down its development, and indeed for those on the borderline, lifestyle alterations and occasionally pharmacological interventions may be enough to prevent progression to established disease. This is particularly true of diabetes mellitus.
The basic workup includes measurement of height, weight and blood pressure. Laboratory investigations focus on blood sugars, lipid profile and kidney function tests. Together with information about smoking and alcohol consumption, this data can be appraised to reach a cardiovascular risk, which is usually represented as a percentage. A number under 10 indicates low risk, between 10 and 20 is now considered medium, and over 20 is designated as high risk for a cardiovascular event in the next 10 years, that being any form of myocardial infarction or cerebrovascular accident.
While there are many new and exciting prospects for raising awareness of cardiovascular disease, including blood pressure machines at the end of supermarket tills and firemen checking your pulse at the same time as your smoke detector, I would argue that the most appropriate place for this work is in the dedicated healthcare setting, by specifically trained personnel including doctors, nurses and pharmacists.
As medical professionals we are acutely aware that prevention is better than cure, and the NHS health check presents a valuable opportunity to reconnect with our patients, especially those who may be reluctant to access services, or who attend infrequently. A positive patient experience and the forming of a rapport may mean your advice is taken up and acted upon, with lasting benefits. Those who attend can further be signposted to a large selection of self-help tools including online applications that encourage and track exercise, advise on healthy diet, and monitor alcohol consumption, with the aim of taking ownership and improvement of their personal health.
“The NHS health check presents a valuable opportunity to reconnect with our patients”