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Comparing screening based on the NHS Health Check and Polypill Prevention Programmes in the primary prevention of
Nicholas J Wald1,2, Aroon D Hingorani1,3, Stephen H Vale4
1Institute of Health Informatics, University College London, London, UK.
Objective:
To compare the NHS Health Check Programme with the Polypill Prevention Programme in the primary prevention of heart attacks and strokes.
Design:
Use of published data and methodology to produce flow charts of the two programmes to determine screening performance and heart attacks and strokes prevented.
Setting:
The UK population.
Intervention:
The NHS Health Check Programme using a QRISK score on people aged 40-74 to select those eligible for a statin is compared with the Polypill Prevention Programme in people aged 50 or more to select people for a combination of a statin and three low-dose blood pressure lowering agents. In both programmes, people had no history of heart attack or stroke.
Main Outcome Measures:
In 1000 people, the number of heart attacks and strokes prevented in the two programmes.
Results:
In the hypothetical perfect situation with 100% uptake and adherence to the screening protocol, in every 1000 persons, the NHS Health Check would prevent 287 cases of a heart attack or stroke in individuals who would gain on average about 4 years of life without a heart attack or stroke amounting to 1148 years in total, the precise gain depending on the extent of treatment for those with raised blood pressure, and 136 would be prescribed statins with no benefit. The corresponding figures for the Polypill Prevention Programme are 316 individuals who would, on average, gain 8 years of life without a heart attack or stroke, amounting to 2528 years in total, and 260 prescribed the polypill with no benefit. Based on published estimates of uptake and adherence in the NHS Health Check Programme, in practice only 24 cases per 1000 are currently benefitting instead of 287, amounting to 96 years gained without a heart attack or stroke.
Conclusions:
The Polypill Prevention Programme is by design simpler with the potential of preventing many more heart attacks and strokes than the NHS Health Check Programme.
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