Abstract 1005: Using Routine Data for Cardiovascular Disease Risk Pre-stratification is Effective and Potentially Cost-saving
Introduction: The UK government is introducing a national screening programme for cardiovascular disease (CVD) risk in all adults aged 40 –74 years. The costs and benefits associated with mass screening for CVD are unknown. We hypothesised that compared to mass screening, using routine data or a simple risk score as a first step in a step-wise population screening strategy might be similarly effective at identifying and treating individuals at high risk of CVD.
Methods: Using data on 16,970 men and women free of CVD from the prospective UK EPIC-Norfolk cohort, we examined the potential population impact of different stepwise screening strategies for identifying and treating individuals at high risk of CVD. These included different age and anthropometric cut-off points, the Framingham risk score, the Finnish diabetes risk score (FINDRISC) and the Cambridge diabetes risk score (as an example of a simple risk score using routine data). We calculated the population attributable fraction, the number needed to screen/treat to prevent one new CVD case and the number of new CVD events that could be prevented for each strategy. Relative risk reductions for estimated treatment effects were derived from meta-analyses of clinical trials or national guidelines.
Results: There were 1,362 CVD events over 183,586 person-years of follow-up. Compared to the recommended government strategy of screening all adults aged 40 –74 years, a stepwise screening approach using a simple risk score could prevent a similar number of new CVD events annually in the UK (26,789; 95%CI 20,778 to 36,239 and 25,134; 95%CI 19,450 to 34,134, respectively), but would require only 60% of the population to be invited for a vascular risk assessment. A similar number of new CVD events (25,016; 95%CI 19,563 to 33,372) could also be prevented by inviting all individuals aged 50 –74 years for a vascular assessment. Using the FINDRISC or anthropometric cut-off points for risk pre-stratification had a relatively low population impact.
Conclusion: Compared to the government-recommended screening strategy, an approach using routine data for CVD risk stratification before inviting individuals at high risk for a vascular assessment may be similarly effective at preventing new CVD cases with potential cost-savings.