Cardio Vascular Disease Cure

Summary
This case study describes Abbie, who was in relatively good health, with no clear CVD risk factors and did not require any post-health check follow-up. CVD risk was communicated using heart age and risk manipulation, which prompted Abbie to make dietary changes to address her elevated cholesterol identified in the health check.

Patient
Abbie is a 61-year-old white British female living in a relatively deprived area (IMD decile 2). She does not drink alcohol or smoke, walks at least 10,000 steps a day, and regularly undertakes gardening and housework. She has no family history of CVD and has lost 8kg since her weight was last recorded (8 years previously). She feels that having this type of health check is important and expresses gratitude to the practitioner. Her total cholesterol is slightly elevated, but not enough to warrant follow-up.

Practitioner
This health check is delivered by a British Asian female HCA with 2 years’ experience of delivering health checks and who has received ‘on-the-job’ training (no formal training). The HCA is positive about NHSHCs in general and likes the JBS3 manipulation options. She feels confident in communicating the risk score as the ‘GP has explained it’ to her and thinks that, in general, patients understand the information presented to them.

The NHS Health Check
The health check is shorter than average (just over 17 minutes). However, the HCA talks for a smaller than average proportion of time (46.0%) and Abbie speaks a little more than average for the sample. Abbie’s QRISK2 score is calculated as 4.8%, and her heart age is estimated as 61 (equal to her actual age).

During risk score manipulation, there was discussion around good and bad cholesterol, and how to reduce Abbie’s total cholesterol, which was elevated. Abbie and the HCA appeared to enter into a mutual discussion, which concluded with Abbie thanking the practitioner. Abbie later reflected:

This information was remembered by Abbie, who had implemented some changes: ‘[the practitioner] actually suggested cutting [cheese] down to a couple of times a week, which I have done already, so that definitely has had an impact’. Abbie said during her VSR interview that when ‘information was given to me in the recommendation . . . I have implemented that immediately’. The HCA also liked using the risk manipulation function within JBS3, describing it as an ‘eye opener’ for patients.

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