NHS "mid-life MOT" has marginal health benefits, say researchers

The free NHS "mid-life MOT" offered to all patients across England has only marginal health benefits, according to new research.

The study, by researchers from Imperial College London, reveals the NHS Health Check, which is offered to people every five years between the ages of 40 and 74, only reduces the 10-year risk of cardiovascular disease by 0.21 per cent. This is equivalent to one cardiovascular event – such as a stroke or heart attack - being avoided every year for every 4,762 people who attend a health check. 

The research, published in the Canadian Medical Association Journal, also revealed very small improvements in blood pressure, cholesterol levels and body mass index. There was no increase in the number of people who stopped smoking.

The NHS Health Check, launched in 2009, aims to identify people at high risk of cardiovascular disease - which includes conditions such as heart disease and stroke - and offer preventative treatment.

But Kiara Chang, lead author of the research from the School of Public Health at Imperial, said the new findings question the initiative's effectiveness.

"Cardiovascular disease is the leading cause of death across the world - and so we urgently need effective initiatives to tackle the condition. However, these findings suggest the NHS Health Check scheme offers very modest benefits.”

Patients generally have the check at their GP surgery and are given a cardiovascular risk score based on information such as their blood pressure, body mass index and cholesterol. Based on their risk level, they will be given lifestyle advice to lower their risk, and some might be prescribed statins or other drugs.

The initiative is the largest cardiovascular disease risk assessment programme in the world, and is estimated to cost around £165 million a year, with GPs paid for each patient who undergoes the check.

The findings from the new study, which followed a representative sample of 138,788 people who went for an NHS Health Check between 2009 and 2013, found the programme reduced the 10-year risk of cardiovascular disease by 0.21 per cent. The average follow-up time in the study was two years. The paper found that, in this two-year period, people who attended the health check had a reduction in  body mass index by 0.27 kg/m2 (the official healthy BMI range is 18.5 - 24.9 kg/m2), compared to those who didn’t attend.

The study, which was supported by the NIHR Imperial Biomedical Research Centre, also revealed those who attended the checks had a reduction in total cholesterol of 0.15 mmol/L (an ideal reading is 5mmol/L or less). A healthy blood pressure is considered to be below 120/80 mmHg, and the findings revealed the first number, systolic pressure, reduced by 2.51 mmHg, and the second number, diastolic pressure, by 1.46 mmHg.

The study also revealed only 21 per cent of people eligible for a health check attended the appointment, and that statins were prescribed to 40 per cent of people deemed at high risk of cardiovascular disease. This suggests the programme does not meet national targets, added Kiara Chang.
"Not only are very few people attending the appointments, but the results suggest that among those who do undergo the check, the number of high-risk patients placed on statins is below national guidelines. The NICE guidance suggests all people deemed at high risk of cardiovascular disease should be considered statins, and the Department of Health suggests 85 per cent uptake of statins is required for the NHS Health Check programme to be cost-effective."

The data also revealed that health checks resulted in a 3 per cent increase in the number of people diagnosed with high blood pressure, and 1.31 per cent increase in diabetes diagnoses.

Professor Azeem Majeed, principal investigator of the study from the School of Public Health at Imperial, added that further work must now look at the reasons why the benefits were so slim, as well as evaluating the most recent data from the scheme. The team also hope to see whether certain sectors of the population would benefit from the checks more greatly than others.

"For the NHS Health Check scheme to be effective, it needs to be better planned and implemented – our work will help highlight how this can be done. In future we plan to evaluate whether particular groups - for instance older patients - have greater health benefits from the check than younger patients. It would also be interesting to investigate the reasons why the health check produced such modest benefits. For instance, to evaluate the advice patients are given during the health check.”

This is an independent report commissioned and funded by the Policy Research Programme in the Department of Health. The views expressed are not necessarily those of the Department. The majority of the research was funded by the Policy Research Programme, though some additional support for staff hours came from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre.

" Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis" by Kiara Chu-Mei Chang et al. is published in the Canadian Medical Association Journal