The government’s much hailed National Health Service vascular screening programme may not be the most cost-effective way of identifying patients at risk from diseases such as diabetes and stroke, new research suggests.
Despite a substantial decline in the incidence of heart disease over the last two decades, the UK has one of the highest rates of cardiovascular disease in Europe, and it is still the number one killer in country today, at an estimated cost to the economy of an astonishing £30 billion a year.
The government recently unveiled a new flagship vascular screening programme in a bid to save lives and ultimately alleviate some of the growing pressure on stretched NHS resources, under a new direction towards creating a health climate more centred on the prevention of illness as opposed to ‘merely’ focusing on cure.
Under this screening programme, all adults aged 40-74 not previously diagnosed with diabetes, cardiovascular disease or hypertension will be offered a health MOT at their local GP surgery, with the aim of determining the level of risk of such diseases through a variety of measures, and subsequently providing medical advice of intervention if required.
It is claimed that, for an annual cost of around £250 million, the programme could help to prevent almost 10,000 heart attacks and strokes every year. However, researchers from Cambridge note that these estimates are “largely based on modelling studies using cross sectional data, with several key assumptions”, and that “the costs and benefits associated with mass screening for cardiovascular disease are unknown”.
The team took a closer look at the potential outcomes of the government’s vascular screening programme and compared it with various different risk assessment scenarios, including inviting people from a smaller age range (between 50 and 74) or only those who are overweight, getting patients to fill in a popular heart risk disease questionnaire, or determining those most at risk from data on electronic patient records.
The researchers found that actually a similar number of new cardiovascular episodes could be prevented if health services used medical records to determine those in the population at greatest risk before inviting them for in for a more thorough health check.
This, they argue, has the potential to cut down on the number of people attending surgery for vascular screening, which would save on resources and staff time, thereby lowering the cost of the programme overall. In addition, they say a similar benefit could also be achieved if checks were limited to adults aged over 50.
Unrealistic to implement?
“A universal screening programme for cardiovascular disease might prevent an important number of new cardiovascular events in a population, but it may be unrealistic to implement in increasingly resource constrained health systems,” commented lead researcher Simon Griffin, of the Institute of Metabolic Science, Cambridge.
“Policy makers have to decide on the balance between the number of people needed to screen or treat and the number of cases that can be prevented in the population”, he said.
But Judy O’Sullivan, Senior Cardiac Nurse at the British Heart Foundation, stressed that whatever the approach the health service “must make sure they not only find those who are at high risk but also those who are most vulnerable,” because those at high risk are often from poorer or ethnic minority backgrounds and are less likely to see their GP.
“Identifying people is just the first step, people also need to be supported to make life-long lifestyle changes to lower their risk of developing cardiovascular disease,” she added.
