New data from the UK Whitehall II study suggest uniform five-year screening intervals for patients with low and intermediate risk for cardiovascular disease (CVD) leads to unnecessarily long delays in detection of high-risk individuals.
A study, published in the Lancet Public Health, found five-year intervals were unnecessarily frequent for low-risk individuals and insufficiently frequent for intermediate-high-risk individuals.
The study used data from participants in the Whitehall II study (aged 40-64 years at baseline) who had repeated biomedical screenings at five-year intervals and linked these data to electronic health records between baseline (7 August 1991 to 10 May 1993) and 30 June 2015.
Of 6964 participants with 152,700 person-years of follow-up, 1686 progressed to the high-risk category and 617 had a major cardiovascular event.
With the five-year screening intervals, participants spent 7866 person-years unrecognised in the high-risk group. For individuals in the low, intermediate-low and intermediate-high risk categories, 21 alternative risk category-based screening intervals outperformed the five-yearly screening protocol.
The authors say introducing seven-year screening intervals for low-risk patients along with four-year intervals for intermediate-low-risk patients and one-year intervals for intermediate-high-risk would reduce the number of person-years spent unrecognised in the high-risk group by 62 per cent (95% CI, 57-66), while also reducing the number of major cardiovascular events by 8 per cent (95% CI, 7-9 events).
They suggest that screening intervals based on risk-category-specific progression rates would perform better in terms of preventing major CVD events and improving cost-effectiveness.