Healthy Hearts - a community-based primary prevention programme to reduce coronary heart disease

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Abstract

Background
The ten year probability of cardiovascular events can be calculated, but many people are unaware of their risk and unclear how to reduce it. The im of this study was to assess whether a community based intervention, for men and women aged between 45 and 64 years without pre-existing coronary heart disease, ould educe their Framingham scores when reassessed one year later.

Methods
Individuals in the relevant age group from a defined geographical area were ent an invitation to attend for an assessment of their cardiovascular risk. Individuals with pre-existing cardiovascular disease or terminal illness were excluded. The invitation was n he form of a \Many Happy Returns\" card with a number of self-screening questions including the question, \"If you put the enclosed string around your waist, is it too short?\" he ard contained a red 80cm piece of string in the case of women, or a green 94cm piece of string in the case of men. At the assessment appointment, Framingham scores were alculated and a printout was given to each individual. Advice was provided for relevant risk factors identified using agreed guidelines. If appropriate, onward referral was also ade o a GP, dietician, an exercise referral scheme, or to smoking cessation services, using a set of guidelines. Individuals were sent a second invitation one year later to return for e-assessment.

Results and discussion
2031 individuals were asked to self -assess their eligibility to participate, 596 individuals attended for assessment nd 313 of these attended for follow-up one year later. The mean reduction in the Framingham risk score, was significantly lower at one year (0.876, 95% CI 0.211 to 1.541, = .01). The mean 10-year risk of CHD at baseline was 13.14% (SD 9.18) and had fallen at follow-up to 12.34% (SD 8.71), a mean reduction of 6.7% of the initial 10-year ramingham risk. If sustained, the estimated NNT to prevent each year of CHD would be 1141 (95% CI 4739 to 649) individual appointments.

Conclusions
This community intervention for primary prevention of CHD reduces Framingham risk scores at one year in those who engage with the programme.

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Background
A case can be made for identifying ├óÔé¼´åİat risk™ individuals, particularly over 45 years of age and for providing them with advice on reducing their risk. here is good evidence that secondary prevention interventions are effective2, 3 but there is less evidence for interventions aimed at primary prevention of CHD. Most general practitioners (GPs) undertake opportunistic screening and have compiled CHD registers. However, many individuals are not identified by this opportunistic screening, either because they have not attended their GP, have not been opportunistically assessed when visiting their GP, or perhaps have not been identified as ├óÔé¼´åİat risk™ of CHD because they avoid contact with health service providers. Universal screening of the whole population is not merited as the risk of CHD rises with age and the great majority of individuals younger than 45 years have a low risk of CHD in the subsequent 10 years. This study consequently encouraged a degree of self selection using a range of self assessment criteria, although patients not meeting these criteria were not rigidly excluded.

Consequently, the aim of this study was to assess whether a community based intervention, for men and women aged between 45 and 64 years without pre-existing coronary heart disease, would reduce their Framingham risk scores then reassessed one year later. A secondary aim of this study was to assess which risk factors had changed most over the course of the year and so contributed most to any education in Framingham risk scores.

Methods
Men and women aged between 45 and 64 years and registered with three GP practice sin the Rhymney alley, Wales were identified. The practices had 4,672 patients registered with them in the relevant age group. This area was chosen because it has a high level of social deprivation and a high Standardised Mortality Rate for CHD. Individuals who had pre-existing cardiovascular disease and were on the practices™ CHD registers were identified and excluded, as were patients with known terminal disease. Each week between September 2004 and March 2005, approximately 200individuals in the relevant age group were sent an invitation to self-screen for eligibility to attend for an assessment of their risk of heart disease until all eligible patients in the GP practices had been invited. The invitation was in the form of a ├óÔé¼┼øMany Happy Returns├óÔé¼┼Ñ card containing a number or questions and enclosing a red80cm piece of string in the case of women, and enclosing a green 94cm piece of string in the case of men. The invitation card, which was intended to stimulate reflection on CHD risk factors, included the following: ├óÔé¼┼øHave you ever been told you have high blood pressure? Have you ever been told you have high cholesterol? Do you smoke now or have you smoked in the past 15 years? Has your other, father, brother or sister ever had heart problems, before they were 60 years old? If you put the enclosed string around your waist, is it too short? You could benefit from a free health check to help prevent heart problems if you ticked any of the ├óÔé¼´åİyes™ boxes├óÔé¼┼Ñ. The card invited eligible individuals to phone and make an appointment for the assessment. A single reminder was sent out two weeks after the first invitation. When individuals telephoned the free telephone number provided, a range of dates were offered over the subsequent four weeks for the assessment to be undertaken.

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