Simulation of alternative designs of a cardiovascular risk reduction program for the U.S. Air Force

A screening and intervention program, soon to be implemented by the U.S. Air Force, will screen personnel for cardiovascular risk and treat those at highest risk. Design alternatives were analyzed relating to the organization and method of delivery of this health service program. A simulation model was devised to aid the analysis. It includes the effect of turnover of personnel, the effect of treatment on the therapy group, and the effect of aging on blood pressure and cholesterol level. The model determines how the overall incidence of cardiovascular disease in the U.S. Air Force may be expected to change each year through a 20-year period under each of several design policies. Results are given to justify the choice of several design options, and the scope of future improvements in the simulation are outlined. It appears possible to achieve a reduction of one-third in the calculated risk of cardiovascular disease, and this more than justifies the risk reduction program, based on a cost-effectiveness study performed earlier. All design decisions have not been made but will await the result of a demonstration implementation. The demonstration will produce more accurate data on initial distribution of risk factors and effect of therapy, which in turn will permit a sharpening of the analyses presented here.