Effect of non-attenders on the potential of a primary care programme to reduce cardiovascular risk in the population

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Abstract
Objectives: To determine the feasibility of enrolling non-attenders of a population based cardiovascular risk reduction programme (the British family heart study) into a further, similar programme and to assess the effect of non-attendance on the effectiveness of the programme. Design: Follow up of non-attenders by practice nurses, including home visits if necessary, to administer questionnaires and obtain physiological measurements. Setting: Eight general practices across England, Scotland, and Wales. Subjects—Non-attenders in a cardiovascular risk factor screening and intervention programme compared with attenders. Main outcome measures: Number of nonattenders enrolled; sociodemographic characteristics; personal and family history of coronary heart disease; cardiovascular risk factors; and total coronary risk score. Results: Data were collected from 106 (17%) of the 608 non-attending families (99 men and 42 women). Of the 543 non-attending families from five practices that attempted complete follow up, 256 had moved away or died. Only 76 were eventually enrolled into the study. The prevalence of coronary heart disease and a family history of coronary heart disease were similar among non-attenders and attenders as were the individual coronary risk factors studied except smoking. Women non-attenders were more likely to be current cigarette smokers than attenders (15/42 (upsilon) 202/948, P = 0.02). Conclusions: The intensive follow up of nonattenders resulted in real intervention opportunities in only a small number. Since the effect of any intervention in a population is reduced by nonattendance audit of preventive medical programmes aimed at the population should allow for the effect of non-attenders on the overall results.