NHS Health Check Training for Healthy Living Centre Staff and Colleagues. June 2015 Amanda Chappell
Aim of the session 1. Increase your understanding of the cardiovascular system 2. Describe the most common types of cardiovascular disease ( CVD) and the causes 3. Understand which lifestyle risks increase the prevalence of CVD ( and other diseases) 4. Highlight the top 7 causes of cardiovascular ( and other) disease ( that are modifiable) 5. Understand the components of an NHS Health Check 6. To understand the importance of brief interventions to ensure that each health check ( every contact counts) matters N.B Session 2 ( see slides shared) will cover ; using motivational interviewing skills/principles ( OARS) to communicate results and support behaviour change
The cardiovascular system ( simplified)
What are the components of the cardiovascular system? The cardiovascular system consists of : 1. The heart, 2. Blood vessels, 3. Blood.
What is the cardiovascular system? 1. Heart
What is the cardiovascular system? 2. Blood Vessels
What is the cardiovascular system? 3. Blood
The cardiovascular system and its function This system has three main functions: 1. Transport of nutrients, oxygen, and hormones to cells throughout the body 2. Removal of metabolic wastes (carbon dioxide, nitrogenous wastes). 3. Protection of the body by white blood cells, antibodies, and complement proteins that circulate in the blood and defend the body against foreign microbes and toxins. Clotting mechanisms are also present that protect the body from blood loss after injuries.
The most common forms of Cardiovascular Disease and the causes Cardiovascular disease (CVD) is a general term that describes a disease of the heart or blood vessels. There are four main types of CVD. They are: 1. Coronary heart disease 2. Stroke 3. Peripheral arterial disease 4. Aortic disease
The common risk factors including lifestyle factors ( 95% are modifiable) which determine the risk of cardiovascular disease The top 7 causes of preventable deaths: 1. High blood pressure 2. Smoking 3. High Cholesterol 4. Obesity 5. Poor diet 6. Physical inactivity 7. Alcohol consumption. The early identification and management of these risks could substantially reduce morbidity, mortality and health inequalities that result from the diseases they cause. Public Health England May 2015
What are the benefits of the NHS Health Check Programme? Modifying risk factors can reduce risk and help people to live well for longer To support early identification of cardiovascular disease and promote positive lifestyle changes, so to reduce premature mortality, disability and poor quality of life. To promote and signpost to lifestyle services to support good health now and in the future An opportunity to increase awareness and knowledge of public health priorities, primary prevention and the promotion of healthy living amongst health and social care colleagues An opportunity for Public Health to work alongside community based partner organisations in new and innovative ways to improve their communities health and reduce health inequalities. A vehicle to raise awareness of dementia Modeling shows the program could prevent 1,600 heart attacks and strokes, save 650 lives per year, prevent 4000 people developing diabetes and detect 20,000 cases of diabetes
Legal requirements In 2013 the program became a mandated Public Health service Local Authorities (LA s) have a legal duty to make arrangements of an offer to the eligible cohort LA s are required to continuously improve the % uptake and coverage The tests, risk assessment elements are specified in legislation to ensure delivery of a uniform, quality offer across the LA s. Data reporting on the program is submitted to central government. The health check results need to be recorded. Outreach Health Check the data needs to go back to the persons GP
Making Every Contact Count Making Every Contact Count is a concept which aims to improve lifestyles and reduce health inequalities Making Every Contact Count (MECC) is about empowering everyone that works in health and social care to inform and enable others to make positive changes to their lifestyles. By delivering consistent and simple healthy lifestyle advice combined with appropriate signposting to lifestyle services all staff can deliver MECC and embed the delivery of healthy lifestyle advice into the day-today activity of the health and social care sector.
The 3 key components of an NHS Health Check 1. Risk assessment 2. Risk awareness 3. Risk management Standardised tests used to measure risk Communicate CVD risk as well as inform a discussion on Lifestyle and medical approach to reduce/manage risk
Elements of the NHS Health Check
Elements of an NHS Health Check Risk Assessment Risk Awareness Risk Management Personal details Clinical Measurements Lifestyle Assessment Prevention /management advice Ethnicity Pulse Diet Communication of results (including Qrisk2) Family history Blood Pressure ( BP) BMI Alcohol intake ( Audit C) Smoking status Goal setting Referral and signposting Cholesterol Exercise (GPAQQ)
Risk Assessment
Clinical Measurements
What is a pulse/heart rate? Your pulse is the rate at which your heart beats. Your pulse is usually called your heart rate, which is the number of times your heart beats each minute (bpm). But the rhythm and strength of the heartbeat can also be noted, as well as whether the blood vessel feels hard or soft.
Finding your pulse You can find your pulse in places where an artery passes close to your skin, such as your wrist or neck. To find your pulse in your wrist: hold out one of your hands, with your palm facing upwards and your elbow slightly bent put the first finger (index) and middle finger of your other hand on the inside of your wrist, at the base of your thumb press your skin lightly until you can feel your pulse if you can't feel anything, you may need to press a little harder or move your fingers around
What is blood pressure? When your heart beats, it pumps blood round your body to give it the energy and oxygen it needs. As the blood moves, it pushes against the sides of the blood vessels. The strength of this pushing is your blood pressure. If your blood pressure is too high, it puts extra strain on your arteries (and your heart) and this may lead to heart attacks and strokes.
What is blood pressure? What do the numbers mean? Every blood pressure reading consists of two numbers or levels. They are shown as one number on top of the other. The first (or top) number is your systolic blood pressure. It is the highest level your blood pressure reaches when your heart beats. The second (or bottom) number is your diastolic blood pressure. It is the lowest level your blood pressure reaches as your heart relaxes between beats.
How to lower your blood pressure Eat well, be active, have a healthy weight An unhealthy lifestyle will raise your blood pressure over time. And the higher your blood pressure becomes, the higher your risk of having a stroke or heart attack in the future. But the good news is that if you have high blood pressure, healthy changes will help to bring it down. And you don't have to wait until you have high blood pressure to make healthy lifestyle changes. The more you can reduce your blood pressure, the lower your risk of a heart attack or stroke will be.
Body Mass Index ( BMI) BMI is a measure that adults can use to see if they are a healthy weight for their height. What is a healthy BMI? For most adults, an ideal BMI is in the 18.5-24.9 range. If your BMI is 25 or more, you weigh more than is ideal for your height: 25-29.9 is overweight 30-39.9 is obese 40 or more is very obese If your BMI is less than 18.5, you weigh less than is ideal for your height. The BMI threshold for some Black Asian Minority ( BAME) Groups varies ( see our local pathway)
What is cholesterol? To understand high blood cholesterol (ko-les-ter-ol), it helps to learn about cholesterol. Cholesterol is a waxy, fat-like substance that s found in all cells of the body. Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs. However, cholesterol also is found in some of the foods you eat. Cholesterol travels through your bloodstream in small packages called lipoproteins (lip-o-pro-teens). These packages are made of fat (lipid) on the inside and proteins on the outside.
What is cholesterol? Two kinds of lipoproteins carry cholesterol throughout your body: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Having healthy levels of both types of lipoproteins is important. LDL cholesterol sometimes is called bad cholesterol. A high LDL level leads to a build-up of cholesterol in your arteries. (Arteries are blood vessels that carry blood from your heart to your body.) HDL cholesterol sometimes is called good cholesterol. This is because it carries cholesterol from other parts of your body back to your liver. Your liver removes the cholesterol from your body.
Cholesterol build up and plaque formation
What is high blood cholesterol? High blood cholesterol is a condition in which you have too much cholesterol in your blood. By itself, the condition usually has no signs or symptoms. Thus, many people don t know that their cholesterol levels are too high. People who have high blood cholesterol have a greater chance of getting coronary heart disease, also called coronary artery disease. (In this article, the term heart disease refers to coronary heart disease.) The higher the level of LDL cholesterol in your blood, the GREATER your chance is of getting heart disease. The higher the level of HDL cholesterol in your blood, the LOWER your chance is of getting heart disease. Coronary heart disease is a condition in which plaque (plak) builds up inside the coronary (heart) arteries. Plaque is made up of cholesterol, fat, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).
Lifestyle Assessment
Food and Diet
What is Audit C? The Audit C is an alcohol screen that can help identify people that are hazardous drinkers or have active alcohol use ( including alcohol abuse and dependence) The first three questions in the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) give health professionals a nonconfrontational tool to explore a patient s relationship with alcohol If patients score 5 they are 'AUDIT-C positive', and the next step is to ask the remaining seven questions to assess their risk.
What is GPAQ? General Practice Physical Activity Questionnaire The Global Physical Activity Questionnaire collects information on physical activity participation in three settings (often referred to as domains) and sedentary behaviour. These domains are: 1. Activity at work 2. Travel to and from places 3. Recreational activities
What is Qrisk2? The Qrisk 2 is the risk calculator that should be used during a health check to communicate risk. A 15 % risk score means that in a crowd of 100 people with similar risk factors 15 out of 100 are likely to be at risk of heart disease or stroke over the next ten years A risk score >10% refer for further assessment ( always offer lifestyle support) The risk score isn t a certainty, but can aid clinical decision making. It should always be communicated with other risk factors ( e.g. high blood pressure, smoking, unhealthy weight etc) http://www.qrisk.org/ The Heart Age Tool, can be useful to share with clients as they can remove or reduce current lifestyle risks ( such as smoking etc), to see how their heart age can be improved https://www.nhs.uk/conditions/nhs-health-check/pages/check-your-heartage-tool.aspx
Dementia Information giving 65-74 year olds only Understand the link between dementia and cardiovascular disease Take action to reduce the risk of developing dementia Learn about services available for information and support ELearning Module available below http://www.healthcheck.nhs.uk/increasingdementia-awareness-training-resource/