CHARIOT: A Cardiovascular Health Assessment and Risk-based Intervention Optimisation Tool embedded within the patient-facing health record

Diseases of the heart and circulation cause a quarter (>160,000) of all deaths in the UK every year. In England, healthy people between 40 and 74 years old can have an NHS Health Check. This involves a nurse or healthcare assistant taking a blood sample, checking blood pressure, weight, and asking about lifestyle and family history. This information is entered into a risk calculator that works out that person’s risk of having a stroke or a heart attack in the next 10 years. If their risk is 10% or higher, they should be invited to see their GP to discuss ways to reduce this risk. The health check has reduced the number of people who have had a stroke, and spurred people on to make healthy lifestyle changes. Despite this, many people do not fully understand their risk score, or find the lifestyle advice they are given too impersonal.

Research suggests that people are more likely to change their behaviour if information about health risks are personally relevant, if it is clear how taking specific actions will reduce their risk, and if they are supported to take these actions. GPs can use the risk calculator mentioned above to show patients how much starting a cholesterol lowering medicine would reduce their risk of having a stroke or a heart attack in the next 10 years.

The calculator is not designed to work out how much other changes, such as losing weight or reducing blood pressure, would reduce someone’s risk of having a stroke or heart attack. For example, it looks at things like weight and blood pressure separately, and does not account for the fact that changing one thing (like losing weight) can have a knock-on effect on other things that also increase your risk of a stroke or a heart attack (like high blood pressure). If someone loses enough weight, for example, it is likely that their blood pressure will also improve.

We will develop an improved risk calculator using a statistical technique called ‘causal inference’. This technique bases risk on cause-and-effect relationships, which makes it possible to ask ‘what if?’ questions, like ‘what if I lost 2 stone?’. This will give more accurate estimates of how much lifestyle changes (such as losing weight or stopping smoking) could reduce someone’s risk of a stroke or heart attack.

Future work will build the improved calculator into GP systems and apps that let patients access their own GP health record and test if giving people the opportunity to experiment with this (e.g. see what would happen to their risk of a stroke or heart attack if they lost 2 stone, or stopped smoking) motivates them to make health related behaviour changes.

Amount awarded: £55,000