EFFECT OF NONATTENDERS ON THE POTENTIAL OF A PRIMARY-CARE PROGRAM TO REDUCE CARDIOVASCULAR RISK IN THE POPULATION

Objectives-To determine the feasibility of enrolling non-attenders of a population based cardiovascular risk reduction programme (the Britis h family heart study) into a further, similar programme and to assess the effect of non-attendance on the effectiveness of the programme. De sign-Follow up of non-attenders by practice nurses, including home vis its if necessary, to administer questionnaires and obtain physiologica l measurements. Setting-Eight general practices across England, Scotla nd, and Wales. Subjects-Non-attenders in a cardiovascular risk factor screening and intervention programme compared with attenders. Main out come measures-Number of nonattenders enrolled; sociodemographic charac teristics; personal and family history of coronary heart disease; card iovascular risk factors; and total coronary risk score. Results-Data w ere 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 h eart disease and a family history of coronary heart disease were simil ar among non-attenders and attenders as were the individual coronary r isk factors studied except smoking. Women non-attenders were more like ly to be current cigarette smokers than attenders (15/42 v 202/948, P = 0.02). Conclusions-The intensive follow up of nonattenders resulted in real intervention opportunities in only a small number. Since the e ffect 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.