H. Kroening, J. Hoare, P. Giri

Sheffield Occupational Health Service, Sheffield Teaching Hospitals NHS Foundation Trust

Background

• Occupational Health Services (OHS) play important roles in employee health promotion1
• Cardiovascular diseases (CVD) represent significant causes of morbidity/mortality, making risk assessment (including for occult comorbidities) desirable2,3
• The evidence-based QRISK3® calculator quantifies CVD risk based on (non)modifiable risk factors4,5
• With proposed links between CVD, Covid-19 and ethnicity, the Coronavirus pandemic presented a unique opportunity for an NHS OHS to assess staff and provide risk factor modification advice

Aims

Urgent need to stratify adverse outcome risk following Coronavirus infection and potential links with CVD risk accelerated demand for quick/effective assessment.

Methods

• Staff aged ≥25 invited for assessment via clinical information (past medical, family history, current medication), measurement of BP, height, weight, and blood tests (renal function, lipids and HbA1c)
• Those with “increased” (>10%)/“high” (>20%) risk or unexpected results were contacted with appropriate medical advice
• Computed QRISK formed the basis for Trust guidance stratification, facilitating pandemic hospital workforce deployment management decisions

Results

• 1075 (5.96% of 18025 staff) participated (25.4% BAME; 75.5% female; 91.8% aged ≥45)
• 7.1% were “high” risk, 4.7% “increased” risk
• unknown comorbidities were identified: CKD stage 3+ (21), pre-diabetes (42), diabetes (15), raised total/HDL cholesterol (40), hypertension (188)
• 35.5% were overweight, 36.2% obese

Conclusions

• 11.8% had (probably unknowingly) elevated CVD risk
• some had “silent” comorbidities requiring medical attention
• with pandemic-related workforce deployment, this risk stratification programme facilitated early intervention and provided health promotion opportunities (medication, lifestyle advice ~ smoking, exercise, diet, alcohol, weight) with occupational and public health benefits
• this provides scope for development of future standard OH programmes

References:

1. Black C. Dame Carol Black’s Review of the Health of Britain’s Working Age Population: Working for a Healthier Tomorrow. 2008. www.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdf
2. Merrill RM, Aldana SG, Ellrodt G, Orsi R, Grelle-Laramee J. Efficacy of the Berkshire Health System Cardiovascular Health Risk Reduction Program. J Occup Environ Med 2009;51:1024–1031. 10.
3. Nilsson PM, Klasson EB, Nyberg P. Life-style intervention at the worksite—reduction of cardiovascular risk factors in a randomized study. Scand J Work Environ Health 2001;27:57–62.
4. https://qrisk.org/three/
5. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study | The BMJ Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2099 (Published 23 May 2017)Cite this as: BMJ 2017;357:j2099