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The NHS lacks cardiovascular screening tools suitable for patients of South Asian descent

BMJ 2015; 350 doi: (Published 09 January 2015) Cite this as: BMJ 2015;350:h52
  1. Kirti Kain, clinical senior lecturer in cardiovascular medicine, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT
  1. k.kain{at}

The Quality and Outcomes Framework and NHS Health Check rely on algorithms based on the risk profiles of people of European ancestry, and they may give false reassurance or anxiety to others, warns Kirti Kain

The NHS Health Check website gives an assessment of circulatory health for adults in England aged 40-74. By acting to reduce their diabetes risk, users can help to prevent the condition and its costly complications. The clinical screening tools consider risk factors such as blood pressure, body mass index, and total cholesterol. But this personalised risk assessment is unsatisfactory, because it does not cater for different populations. Depending on the population and the background risk, the risk assessment could be falsely low or high, giving false reassurance or anxiety.

Likewise, the targets of the Quality and Outcomes Framework (QOF) in England are inappropriate for different populations. To manage chronic diseases such as cardiovascular disease and diabetes, QOF targets include total cholesterol and blood pressure at a specific threshold in the preceding 15 months. But the 2011 census showed that the number of foreign born residents in England and Wales had risen, and the most common birthplaces outside the United Kingdom were India (694 000), Poland (579 000), and Pakistan (482 000).

Different risk factor profile

South Asians (originally from India, Pakistan, …

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