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Supported by: Understanding the Delivery of an NHS Health Check Hand-outs Booklet September 2022 Accreditedby: Registered office: 2-6 Boundary Row, LondoTel: 0330 124 1966 www.smarthealthsolutions.co.ukWhat are we trying to prevent? Genes Inflammation Risk Factors 1NHS Health Check: Best Practice Guidance Figure 2. Overview of the vascular risk assessment and management programme 23456 This is one unit of alcohol… Halfpintof Half a small 1single 1small 1 single “regular”beer, glassof measure glassof measureof lagerorcider wine ofspirits sherry aperitifs …and each of these is more than one unit 2 3 4 9 1.5 2 3 Pintof Pintof “strong”or Alcopopora 440mlcanof 440mlcanof 250mlglassof 75clBottleof “regular”beer, ”premium”beer, 275mlbottleof “regular”lager “super wine(12%) wine(12%) lagerorcider lagerorcider regularlager orcider strength”lager AUDIT–C Scoring system Your Questions score 0 1 2 3 4 2 - 4 2 - 3 4+ How often do you have a drink containing Never Monthly times times times alcohol? or less per per per month week week How many units of alcohol do you drink on a typical day when you are drinking? 0 - 2 3 - 4 5 - 6 7 - 9 10+ How often have you had 6 or more units if Less Daily female, or 8 or more if male, on a single Never than Monthly Weekly or monthly almost occasion in the last year? daily Scoring: A total of 5+ indicates increasing or higher risk drinking. An overall total score of 5 or above is AUDIT-C positive. SCORE 7Score from AUDIT- C (other side) SCORE Remaining AUDIT questions Scoring system Your Questions score 0 1 2 3 4 How often during the last year have you found Less Daily that you were not able to stop drinking once you Never than Monthly Weekly or almost had started? monthly daily Daily How often during the last year have you failed to Less do what was normally expected from you Never than Monthly Weekly or because of your drinking? monthly almost daily Daily How often during the last year have you needed Less or an alcoholic drink in the morning to get yourself Never than Monthly Weekly almost going after a heavy drinking session? monthly daily Less Daily How often during the last year have you had a Never than Monthly Weekly or feeling of guilt or remorse after drinking? almost monthly daily Daily How often during the last year have you been Less unable to remember what happened the night Never than Monthly Weekly or before because you had been drinking? monthly almost daily Yes, Yes, but not during Have you or somebody else been injured as a No in the the result of your drinking? last last year year Yes, Yes, Has a relative or friend, doctor or other health but not during worker been concerned about your drinking or No in the the suggested that you cut down? last last year year Scoring: 0 – 7 Lower risk, 8 – 15 Increasing risk, 16 – 19 Higher risk, 20+ Possible dependence TOTAL TOTAL Score equals AUDIT C Score (above) + Score of remaining questions 8General Practice Physical Activity Questionnaire Date……………………… Name…………………….. 1. Please tell us the type and amount of physical activity involved in your work. Please mark one box only I am not in employment (e.g. retired, retired for health reasons, unemployed, a full-time carer etc.) b I spend most of my time at work sitting (such as in an office) I spend most of my time at work standing or walking. However, my work does c not require much intense physical effort (e.g. shop assistant, hairdresser, security guard, childminder, etc.) My work involves definite physical effort including handling of heavy objects d and use of tools (e.g. plumber, electrician, carpenter, cleaner, hospital nurse, gardener, postal delivery workers etc.) My work involves vigorous physical activity including handling of very heavy e objects (e.g. scaffolder, construction worker, refuse collector, etc.) 2. During the last week, how many hours did you spend on each of the following activities? Please answer whether you are in employment or not Please mark one box only on each row None Some but 1 hour but 3 hours or less than less than more 1 hour 3 hours Physical exercise such as swimming, a jogging, aerobics, football, tennis, gym workout etc. Cycling, including cycling to work and b during leisure time c Walking, including walking to work, shopping, for pleasure etc. d Housework/Childcare e Gardening/DIY 3. How would you describe your usual walking pace? Please mark one boxonly. Slow pace Steady average pace (i.e. less than 3mph) Brisk pace Fast pace (i.e. over 4mph) Hit return to calculate PAI 9 THE NHS HEALTH CHECK AND FAMILIAL HYPERCHOLESTEROLAEMIA Why is a diagnosis of Familial Hypercholesterolaemia (FH) important? Since monogenic FH is a single gene disorder and ‘runs in families’, 50% of the brothers and sisters and 50% of the children of your FH patient are at risk of also having FH. If the diagnosis of FH is confirmed, they can easily be offered diagnostic tests and affected individuals effectively treated with statins to reduce their subsequent risk of early onset heartdisease. What should a GP do when an individual has been identified through the NHS Health Check programme with a total cholesterol of > 7.5 mmol/L? The following steps should be carried out: • Repeat the measurement on a fasting blood sample. The laboratory can then calculate the LDL cholesterol concentration. The diagnostic cut-off for a possible diagnosis of FH in an adult is a total cholesterol of > 7.5 mmol/L but more specifically an LDL cholesterol of > 4.9mmol/L. • If on the retest the LDL is >4.9 mmol/L, exclude secondary causes of hypercholesterolaemia. These are: (a) Hypothyroidism (measure TSH levels) (b) Renal impairment measurecreatinine) (c) Obstructive liver disease (measure liver function tests) (d) Diabetes (using a fasting blood glucose measure) – usually associated with hypertriglyceridaemia • If secondary causes of hypercholesterolaemia have been excluded, or the patient continues to have a high cholesterol despite management of the secondary cause, then the patient should be referred to a local lipid clinic. The clinic will carry out further tests and take a detailed family history for the confirmation of the diagnosis. If not confirmed, the patient will be referred back to the GP. If confirmed the clinic will, initiate intensive statin therapy and cascade testing of affected relatives. Usually once the NICE recommend lipid lowering for FH patients is achieved (target of 50% lowering of pre-treatment LDL cholesterol) the patient will be discharged back to the GP for a shared care arrangement and agreed annual review schedule as recommended by the NICE guidelines. Click here to use the HEARTUK lipid clinic finder http://www.heartuk.org.uk/lipidclinics/index.php?/clinics/postcode/ To Note: 101 The probability of an individual having FH is increased by the degree of elevation of LDL cholesterol. While an LDL of 4.9-5.5 can be diagnostic of FH, it can also be due to “polygenic” causes. Conversely, in an individual with LDL levels over 6.0 mmol/L polygenic causes are much less likely, and a diagnosis of FH is very much morelikely. 2 Individuals who report having relatives with either elevated cholesterol levels and or early heart disease are very likely to have monogenic FH and should definitely be referred. The NICE guideline suggests using the criteria for early CHD as under 55 years in a first degree male relative and under 65 in a first degree female relative. For other sites with information about FH See the BHF http://www.bhf.org.uk/ and for their factfile on FH see http://www.bhf.org.uk/search/results.aspx?m=simple&q=factfile+FH&subcon=BHF_main_site For the UK FH (Simon Broome ) Register see http://www.heartuk.org.uk/HealthProfessionals/index.php/simon_broome_fh_register/ For the HEARTUK Patient Support group see http://www.heartuk.org.uk/ For the NICE Guideline on FH see http://www.nice.org.uk/nicemedia/live/12048/41697/41697.pdf 11 B lo o dP r e s s u r e M easurem ent With Electronic Blood Pressure Monitors • The patient should be seated for at least 5 minutes, relaxed and not moving or • The arm must be supported at the level of the heart. Ensure no tight clothing constricts the arm; • Place the cuff on neatly with the centre of bladder should encircle at least 80% of the arm (but not more than 100%); • Some monitors allow manual blood choose the appropriate setting. Other you monitors will automatically inflate and re- inflate to the next setting if required; • Repeat three times and record blood pressure in both arms and use armt with highest reading for subsequent measurement. Indication (cm)* = (cm)* = BHwidth & length (cms)*Ar(cm)*c. Cuff Sizes Standard Adultild 12 - 13 23 – 35 12 x 26 < 33 Large Adult 12 - 16 35 – 40 12 x 40 < 50 * The range for columns 2 and 3 are derived from recommendations from the British Hypertension society (BHS), European ** Large bladders for arm circumferences over 42cm may be required.olumns 4 and 5 are derived from only the NHS guidelines. = Bladders of varying sizes are available so a range is provided for each indication (applies to columns 2 and 3). Points to note: It is good practice to occasionally check the monitor against other validated devices. It is important to have the monitor serviced and calibrated according to manufacturer’s guidelines. 12What needs to be done next and what do I do? Needs to be done What do you need to do? BP >140/90 mmHg & Assessment for hypertension ABPM/Home BP <179/119 mmHg Check for DM & CKD BP >180/120 mmHg See duty Dr / ANP See GP/ANP/Pharm CVD Risk >20% Start a statin Annual review See GP/ANP/Pharm, recommend a CVD Risk 10-19% statin. If yes, annual review, if no NHS Health Check in 5 years CVD Risk <10% NHS Health Check in 5 years See GP, check full lipid profile, thyroid, liver, kidney, diabetes. TC>7.5 mml/L Consider FH See duty Dr/ANP/Pharm HbA1c >48 Diabetes prevention programme HbA1c 42-48 Lifestyle advice HbA1c 37-42 Lifestyle advice HbA1c <37 Weight management programme BMI >30 Diabetes prevention programme Audit C>5 Complete rest of Audit C Offer advice, Drink Aware app Audit C 8-19 Referral to specialist alcohol services Audit C >20 ECG Irregular pulse Smoker Stop smoking services Lifestyle Local and national services Better Health 12Useful Websites Alcohol www.drinkaware.co.uk/for-professionals/#health www.e-lfh.org.uk/programmes/alcohol www.alcoholconcern.org.uk/unit-calculator?gclid=CImZu_3KodICFecK0wodYqcLeQ Better Health (was One You) www.nhs.uk/better-health/ British Hypertension Society www.bihsoc.org (Great for validated BP monitors and info for ABPM & HBPM) Charities: www.heartuk.org.uk (Great for cholesterol) * supporters of our training www.bloodpressureuk.org/Home (Great patient info and blood pressure week) www.bhf.org.uk www.diabetes.org.uk Computerized Brain Games www.stayingsharp.aarp.org/about/brain-health/games www.lumosity.com www.brainHQ.com CVD Risk Calculators www.nhs.uk/conditions/nhs-health-check/pages/check-your-heart-age-tool.aspx www.jbs3risk.com/pages/risk_calculator.htm Dementia Leaflet www.healthcheck.nhs.uk/commissioners_and_providers/training/dementia_training www.healthcheck.nhs.uk/commissioners_and_providers/marketing/dementia_resources Free e-Learning www.e-lfh.org.uk/programmes/all-our-health Free LWN Webinars www.learnwithnurses.org NHS Health Checks – template letters, posters and data & statistics www.healthcheck.nhs.uk www.healthcheck.nhs.uk/commissioners-and-providers/national-guidance/ www.healthcheck.nhs.uk/commissioners-and-providers/training/competency-framework-and-learner-and- assessor-workbooks/ Obesity www.cks.nice.org.uk/topics/obesity/diagnosis/identification-classification RCN - Accountability and Delegation www.rcn.org.uk/professional-development/accountability-and-delegation Skills for Health www.skillsforhealth.org.uk/info-hub/category/the-care-certificate/ Registered office: 2-6 Boundary Row, London, SE1 8HPTel: 0330 124 1966 www.smarthealthsolutions.co.uk