Britain's biggest study of using nurses in general practice to screen people for heart disease, and then persuading them to alter diet, smoking and exercise habits while treating them for raised blood pressure and cholesterol, has shown that such a programme provides little benefit.
The interventions used in the British Family Heart Study were more intensive than those the great majority of GPs will be using in the health promotion drive that the Government is paying them to run, according to David Wood, the study team leader and Professor of Clinical Epidemiology at the National Heart and Lung Institute.
The gains from the Government programme are 'likely to be even smaller' the study has concluded, and 'the Government's screening policy cannot be justified by these results'.
When the Government first insisted in 1990 that GPs introduce health promotion clinics, critics argued they would not be cost-effective. The study concludes that such clinics would have produced 'possibly no change at all' in the heart disease risk. The scheme was revised last April to allow less systematic screening, but whether that will achieve useful reductions in risk 'must remain in considerable doubt, and cannot be justified in its present form from the results of this trial' the 15-strong medical team says in today's British Medical Journal.
The study involved almost 12,500 middle-aged men and women in 13 towns in Britain. At the end of the year the combination of screening and lifestyle advice produced a 12 per cent reduction in the risk of coronary heart disease.
Professor Wood said the study should have 'a profound impact on the future direction of the Government's health promotion strategy'. Cutting heart disease and stroke deaths is a Health of the Nation White Paper target; the study team suggests that focusing effort on those who already have heart disease or are known to be at high risk might produce better results.
The Department of Health insisted yesterday that the findings 'do not demonstrate that all health promotion in general practice is ineffective', but said it did show that nurse-led interventions with no GP involvement did not work well.Reuse content