Targeted case finding for cardiovascular preventionBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1376 (Published 25 April 2010) Cite this as: BMJ 2010;340:c1376
All rapid responses
Marshall is correct in his assessment that targeted case finding is
more manageable and may be more effective than untargeted screening in
cardiovascular primary prevention.
Indeed, despite many years of SIGN (and NICE) recommending 5 yearly
screening for all 40-74 year olds there has been variable uptake of this
within primary care and many high risk people still evade risk
stratification and appropriate management.
By interrogating GP patient systems with appropriate software, high
risk cohorts of patients can be identified and targeted first.
In Scotland where the ASSIGN risk calculator is the recommended
method of calculating risk by Quality Improvement Scotland, actual data is
used , but where missing, data can be “assigned” to individual people
using the Scottish default value. The calculator also includes the
Scottish Index of Multiple Deprivation (by linking patient address
postcode) allowing for social deprivation to be included in the
calculation, again helping identify those most at risk. (As well as
tackling health inequalities)
Patients can then be invited in to primary care centres for
screening, to capture and record any missing data, and more accurately
calculate individual risk, offer lifestyle advice , medication where
People who default screening appointments can be “flagged up” to show
their ASSIGN risk score in the GP patient system, to allow opportunistic
screening when they attend primary care for other reasons.
Targeted case finding should allow best use of limited resources
within primary care, help the people most at risk, and hopefully
demonstrate the greatest effect in preventing or postponing cardiovascular
events for those patients entering the more expensive secondary care
The author is leading the GRANITE primary prevention pilot in conjunction with Astra-Zeneca
Competing interests: No competing interests