Open Access Research article

The Sandwell Project: A controlled evaluation of a programme of targeted screening for prevention of cardiovascular disease in primary care

Tom Marshall1*, Paul Westerby2, Jenny Chen2, Mary Fairfield2, Jenny Harding2, Ruth Westerby2, Rajai Ahmad3 and John Middleton2

Author Affiliations

1 Department of Public Health & Epidemiology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

2 Public Health Department, Sandwell Primary Care Trust, Kingston House, 438 High Street, West Bromwich, West Midlands, B70 9LD, UK

3 Cardiology Department, Sandwell District Hospital, Lyndon, West Bromwich, West Midlands B71 4HJ, UK

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BMC Public Health 2008, 8:73  doi:10.1186/1471-2458-8-73

Published: 25 February 2008



A pilot cardiovascular disease prevention project was implemented in the inner-city West Midlands. It was evaluated by comparing its effectiveness to a control group where full implementation was delayed by a year.


Cardiovascular risk factor data were extracted on all untreated patients 35 to 74 years old from electronic medical databases in six general practices. A best estimate of ten-year CVD risk cardiovascular risk was calculated on all patients using the extracted risk factor data. Default risk-factor values were used for all missing risk factor data. High risk patients were thus identified. In four practices a project nurse systematically invited, assessed and referred high risk patients for treatment. Two control practices were provided with a list of their high risk patients. The outcomes were the proportions of untreated high-risk patients who were assessed, identified as eligible for treatment and treated under two strategies for identifying and treating such patients in primary care.


Of all high-risk patients suitable for inclusion in the project, 40.6% (95% CI: 36.7 to 45.7%) of patients in intervention practices were started on treatment were started on at least one treatment, compared to 12.7% (95% CI: 9.8% to 16.1%) in control practices.


A strategy using electronic primary care records to identify high risk patients for CVD prevention works best with a process for acting on information, ensuring patients are invited, assessed and treated.