1. NHS Health Checks Annual review of >20% risk patients Dr Stephen Liversedge – Clinical Lead for Primary care NHS Bolton CCG

2. Outcomes – MI Admissions BBHC commences

3. Outcomes - Mortality

4. CKD Prevalence

5. Health Check Template

6. Health Check Template – physical activity

7. Health Check Template - alcohol

8. Annual Review Template

9. Where are we up to? - NHS Checks  End of March 2013  40 – 74 population122,884  Target number103,122  Completed 80,125  Completed77.7%  Fairly static percentage over the year

10. Where are we up to? - Annual reviews  Over 40 year old142,920  Target number113,639  Risk assessed 88,196  >20% risk of CVD 22,642  Number reviewed 11,768  Percentage reviewed 52%

12. Some Scenarios - No 1  66 year old man  White  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? =

13. Some Scenarios - No 1  66 year old man  White  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 20%

14. Some Scenarios - No 2  66 year old man  White  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Bradshaw BL2 4AL  Risk Score? =

15. Some Scenarios - No 2  66 year old man  White  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Bradshaw BL2 4AL  Risk Score? = 17.8%

16. Some Scenarios - No 3  66 year old Woman  White  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? =

17. Some Scenarios - No 3  66 year old Woman  White  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 14.6%

18. Some Scenarios - No 4  66 year old man  White  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 100kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? =

19. Some Scenarios - No 4  66 year old man  White  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 100kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 20.6%

20. Some Scenarios - No 5  66 year old man  White  Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? =

21. Some Scenarios - No 5  66 year old man  White  Smoker 10-19 cigs a day  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 29.4%

22. Some Scenarios - No 6  66 year old man  Pakistani  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? =

23. Some Scenarios - No 6  66 year old man  Pakistani  Non Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 32.5%

24. Influence of other conditions on Hall I’th’ Wood man  CKD28.2%  Atrial fibrillation29.6%  On BP treatment24.4%  Rh A26.7%  CKD and BP34.0%  CKD AF BP treatment and RhA59.7%

25. Some Scenarios - No 5  66 year old man  White  Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 29.4%

26. Some Scenarios - No 7  66 year old man  White  Ex Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? =

27. Some Scenarios - No 7  66 year old man  White  Ex Smoker  Cholesterol/HDL ratio of 6.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 22.7%

28. Some Scenarios - No 8  66 year old man  White  Ex Smoker  Cholesterol/HDL ratio of 3.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? =

29. Some Scenarios - No 8  66 year old man  White  Ex Smoker  Cholesterol/HDL ratio of 3.0  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 15%

30. Some Scenarios - No 9  66 year old man  White  Non Smoker  Cholesterol 5.7 HDL 2.3  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 12.2%

31. Some Scenarios – No10  ?? year old man  White  Non Smoker  Cholesterol 5.7 HDL 2.3  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 20.0%

32. Some Scenarios – No10  75 year old man  White  Non Smoker  Cholesterol 5.7 HDL 2.3  BP 131/80  183cm 79 kg  Lives in Hall i’th’ Wood BL1 8UA  Risk Score? = 20.0%

33. Conclusions 1  Stop patients smoking  Optimise Cholesterol/HDL ratio using statin where necessary  Control BP  Be aware of the influence of other conditions which may develop such as diabetes, CKD, AF

34. Q Risk 2 web site

35. Explaining Cholesterol/HDL ratio to patients Cholesterol6.07.05.0 HDL1.02.00.5 Cholesterol/HDL Ratio 6.03.510.0

36. Improving HDL levels  Stop smoking - increases by 10%  Take exercise - increases by 5% after 2/12  Lose weight even a few pounds  Choose unsaturated fats – olive oil, nuts, fish  Total fat less than 30%  Saturated fat less than 7%  Only drink alcohol in moderation – increases HDL

37. Q Risk 2 web site

38. Annual Review Template

39. Conclusions 2  Have smokers given up as they promised they would try?  Is BP still OK?  Is pulse sinus rhythm?  Promote alcohol awareness  Promote physical activity  Is weight/waist size increasing?  Review blood tests  Is risk score optimised?

40. Conclusions 3  Blood tests  Lipids – optimal? Are they still taking statins?  LFTs - for statin users, alcohol  HbA1c - Have they become diabetic? At risk of diabetes?  eGFR – for CKD, often a marker for CVD

41. Thank you Any Questions? stephen.liversedge@bolton.nhs.uk