p48-55w13_A&S Template 25/11/2011 11:59 Page 48

Learning zone
CONTINUING PROFESSIONALDEVELOPMENT

4Page 56

Cardiovascular disease
multiple choice
questionnaire

4Page 59

Read Rose Gallachers

practice profile on mental
health in older people

4Page 60

Guidelines on
how to write a
practice profile

An overview of cardiovascular
disease risk assessment
NS621 Westerby R (2011) An overview of cardiovascular disease risk assessment.
Nursing Standard. 26, 13, 48-55. Date of acceptance: July 18 2011.

Abstract
Cardiovascular disease (CVD) risk assessment is being undertaken in
the UK as a result of a national drive to reduce premature mortality and
the economic burden of vascular disease. This article focuses on ways
in which primary care teams can implement a systematic approach to
CVD risk assessment. A systematic approach to CVD risk assessment
includes identification of the target population, the collection of
information and data to calculate a CVD risk score, and management
of the results. Primary care teams can work successfully with lifestyle
teams and public health to provide a comprehensive service.

Author
Ruth Westerby
Clinical lead for cardiovascular disease prevention, stroke and
evidence-based health care, Education for Health, Warwick, and senior
lecturer in health and social care, University of Wolverhampton.
Correspondence to: r.westerby@wlv.ac.uk

Aims and intended learning outcomes

This article aims to provide an overview of
cardiovascular disease (CVD) risk assessment,
including implications for the primary care
team. After reading this article and completing
the time out activities you should be able to:
4Understand the reasons for increasing
access to and the speed of CVD risk
assessment.
4Recognise the ways in which those at
high risk of CVD may be systematically
identified.
4Describe the ways primary care teams can
work with other services in the community
to support the complex process of CVD risk
assessment and management.
4Outline the clinical aspects of CVD risk
assessment.

Keywords
Cardiovascular disease, coronary heart disease, stroke

Review
All articles are subject to external double-blind peer review
and checked for plagiarism using automated software.

Online
Guidelines on writing for publication are available at
www.nursing-standard.co.uk. For related articles visit the
archive and search using the keywords above.

48 november 30 :: vol 26 no 13 :: 2011

Introduction
CVD risk assessment is not solely about
preventing heart attacks. The national
initiative to identify and prevent vascular
diseases (known in England as the Health
Check process) includes heart attack, stroke,
chronic kidney disease and diabetes
(Department of Health (DH) 2009).
Collectively, CVD accounts for 170,000 deaths
each year in England and four million people
living with long-term illness and disability
(DH 2007). The national service frameworks
for chronic heart disease (DH 2000), diabetes
(DH 2001) and renal disease (DH 2005), and
the National Stroke Strategy (DH 2007)
highlight the need for prevention of CVD. The
document Putting Prevention First: Vascular
Checks (DH 2008a) combined the assessment

NURSINGSTANDARD / RCNPUBLISHING

p48-55w13_A&S Template 25/11/2011 11:59 Page 49

of risk for these conditions because many of the

risk factors are the same. These include age,
gender, ethnicity, smoking, physical inactivity,
obesity, blood pressure and blood cholesterol.
In addition, while advances in service provision
such as thrombolysis, angioplasty and
secondary prevention have gone some way to
reducing mortality rates associated with
vascular diseases, there is evidence that the
reduction in these rates is slowing, and an
increasing burden of disease is anticipated
(World Health Organization (WHO) 2009).
Complete time out activity 1
Recently there has been a move to identify
CVD risk in the general population. The
National Service Framework for Coronary
Heart Disease (DH 2000), despite advocating
primary prevention, suggested that people at
high risk of chronic heart disease should be
identified among those with established
diagnoses of diabetes and hypertension rather
than through unselected screening of the
whole population. Putting Prevention First:
Vascular Checks (DH 2008a) suggested that,
as a result of people living longer with disease,
an ageing population and a rise in obesity and
sedentary living, there was a strong economic
argument to identify all people at high risk,
not only of chronic heart disease, but also
those at risk of stroke, chronic kidney disease
and diabetes, and to treat these individuals to
prevent or delay an acute event.
The economic argument is based on data
that shows the cost of treating CVD is
significantly greater than the cost of
preventing it (DH 2008b). Hanlon and
Venters (1998) demonstrated that an acute
event can be delayed significantly via primary
prevention. This reduces the cost of acute
intervention by reducing the length of time
acute intervention is required.
There is also a moral argument for
undertaking a CVD prevention initiative that

considers quality of life after an acute event

such as a heart attack or stroke, and
encourages healthcare professionals to
provide information and treatment to prevent
and reduce the burden of illness on patients
and their families. CVD is responsible for
18% of disability-adjusted life years
(healthy years of life) lost in high income
countries such as the UK (WHO 2009).
CVD risk assessment is available to all adults
aged between 40 and 74 who do not already
have an existing diagnosis of vascular disease.
Assessment results in a score, which indicates
the risk of an individual having a CVD event in
the next ten years. There are approximately
15 million people in England who are eligible
for assessment. Based on an uptake of around
75% of those invited to undergo assessment,
approximately 650 lives are saved per
year, 1,600 heart attacks and strokes are
prevented, 4,000 people are prevented from
developing diabetes and 20,000 new cases of
diabetes are identified earlier (DH 2010).
Similar work is being undertaken in Scotland
via the Keep Well public health initiatives
(www.keepwellscotland.org.uk/about/index.
aspx), and Wales is encouraging broader
vascular assessment on a population basis
(Welsh Assembly Government 2010).
Debate continues about whether such
initiatives are the best way to prevent CVD.
The debate between the high-risk approach
(targeting only those known to be at high risk)
versus the population approach (attempting
to make lifestyle and behaviour changes at a
population level) is evident (Capewell 2008,
Jackson et al 2008). These two approaches are
outlined in Table 1.

Cardiovascular disease risk assessment

It is helpful when preparing to undertake CVD
risk assessment to think about the process in
terms of the following stages:

TABLE 1
Approaches to cardiovascular disease prevention
High-risk approach

Population approach

Targets selected individuals.

Targets the entire population.

Aims to identify and treat people at high risk.

Aims to achieve small changes in highly prevalent risk

factors, such as smoking, low activity levels and obesity.

Attempts to delay consequences.

Attempts to deal with underlying causes.

Involves screening and treatment.

Involves a public health approach.

(Bovet 2009)

NURSINGSTANDARD / RCNPUBLISHING

1 Consider the
reasons why the burden
of CVD is anticipated to
increase. Make a list of
the factors that might
contribute to this and
outline how these could
be addressed.

november 30 :: vol 26 no 13 :: 2011 49

p48-55w13_A&S Template 25/11/2011 11:59 Page 50

Learning zone cardiology focus

4Identification of target population.
4Risk assessment.
4Risk management.
It is important to be aware that the way in
which risk is communicated to an individual
can affect his or her decision making process,
including the decision of whether or not to
attend for assessment or whether to make any
health-related lifestyle changes. The National
Institute for Health and Clinical Excellence
(NICE) (2010) and the Care Quality
Commission (2009) reinforce the need to
engage people in their own assessment of risk,
including levels of knowledge and cultural
perceptions and beliefs, to plan and deliver
services to improve uptake.
Once the measurement of vascular risk has
been undertaken, the UK National Screening
Committee (2008) advocates a two-way
process of communication, which allows the
individuals perceptions and beliefs to be
explored and understood, and action
planning to be supported with appropriate
information. Healthcare professionals need
to consider the resources available to support
this process, and how information about
vascular risk could be shared with patients
in an understandable and personalised way.
Some of the risk assessment tools include
visual displays that are colour coded for ease
of interpretation, and include what if
scenarios, enabling people to see the effect
of taking medication or implementing a
health-related behaviour change.
Complete time out activity 2

2 What CVD risk

assessment tool do you
use in your clinical area?
Do you think it assists
staff in communicating
the concept of risk to
patients?

Identification
Deaths from CVD, particularly premature
deaths, are not evenly distributed in the UK
and it is therefore logical to establish who
and where those most at risk are, and to
start the process in a targeted fashion, within
the context of assessing all people aged
40 to 74. For example, unskilled men
experience three times more deaths from
coronary heart disease than the professional
occupation groups. This is attributed to the
ways in which socioeconomic status affects
lifestyle and behaviour patterns, ease of
access to health care and chronic stress
(WHO 2009).
Deaths are 50% higher in the south Asian
community than in the general population
(Care Quality Commission 2009). People
from India are at less risk than Bangladeshi
and Pakistani communities (Bhopal 2000),
but overall the south Asian population is at
increased risk.

50 november 30 :: vol 26 no 13 :: 2011

Health-related behaviours that may increase

the risk of a heart attack or stroke have been
identified in the INTERHEART study (Yusuf
et al 2004) and the INTERSTROKE study
(ODonnell et al 2010) and include:
4Smoking.
4Hypertension.
4Apolipoprotein B/A1 ratio measured via
a blood test (apolipoprotein B is involved
in production of low density lipoprotein
cholesterol, apolipoprotein A is involved
in production of high density lipoprotein
cholesterol).
4Abdominal obesity.
4Diabetes (Figure 1).
4Low dietary intake of fruit and vegetables.
4Excessive alcohol intake.
4Lack of physical activity.
4Psychosocial factors such as depression,
perceived stress and life events.
These health-related behaviours may be more
common in disadvantaged populations, such
as those on a low income, black and minority
ethnic groups, people with a mental health
problem and people who are homeless.
The Association of Public Health
Observatories (2007) produce health
profiles every year that summarise local
health trends, including health-related
behaviours, and the Office for National
Statistics provides data on causes and
patterns of death and illness. Local
public health departments also provide
information on electoral wards with the
highest levels of premature mortality from
CVD. In addition, GP surgery data can be
used to identify people who are at increased
risk of CVD, based on risk factors such as
age, gender and ethnicity, as well as any
recorded health data such as body mass
index (BMI), blood pressure or cholesterol
levels. In areas where health checks are well
established, there are examples of teams
working with local hospitals that treat
people with heart attacks and stroke to offer
vascular risk assessment for siblings or
children of patients at risk (NHS Health
Check 2010). There are also examples of
targeted work with people who have a
mental health problem, a learning disability
or who belong to an ethnic group at high risk
(NHS Health Check 2010).
Risk assessment
Nationally developed information leaflets
and invitation letters can be used to invite
people to attend for risk assessment.
Guidance on how these may be adapted for

NURSINGSTANDARD / RCNPUBLISHING

p48-55w13_A&S Template 25/11/2011 11:59 Page 51

local use are available in 19 different

languages, Braille and easy read versions
from www.healthcheck.nhs.uk. Risk
assessment includes a series of questions,
measurements and blood tests (Figure 2).
Choice of which type of risk assessment
tool to use will have to be made by the
healthcare professional. NICE (2008b)
guidelines state that while CVD risk
estimation is based on the Framingham
equations developed in the United States,
these have been found to overestimate risk by
up to 50% in populations such as that in the
UK. The Framingham equations make no
allowance for the effect of family history or
ethnicity on risk estimation. Two new risk
estimation tools have been developed for use
in the UK. ASSIGN (Tunstall-Pedoe and
Woodward (2006), Woodward et al (2007))
was developed using a Scottish Cohort, while
QRisk was developed using data from UK
general practices (Hippisley-Cox et al 2007).

Both tools include a measure of additional

factors such as social deprivation and
family history.
The Joint British Societies (JBS) (2005)
guidelines on prevention of cardiovascular
disease incorporate the Framingham equation
and suggest particular adjustments for people
who have a strong family history of CVD or
belong to a high-risk ethnic group. This is
sometimes referred to as the adjusted
Framingham risk assessment. It is important
to agree which assessment tool will be used
locally to ensure consistency.
A person with a medium or low risk of CVD
may still have an abnormal cholesterol profile
or raised blood pressure and might benefit
from clinical review. For this reason, the
development of protocols that guide those
collecting information should include agreed
actions for when results are outside of the
accepted ranges.
Complete time out activity 3

3 Visit the
QRisk2 website at
http://qintervention.org
and input an example of
patient data. Change the
parameters and observe
the effects on overall
risk score.

FIGURE 1
Identification of people at high risk of diabetes
Key
BMI = body mass index
BP = blood pressure
FPG = fasting plasma glucose
HbA1c = glycated haemoglobin
OGTT = oral glucose tolerance test

Person aged 40-74

without diagnosed
existing vascular disease

6.5%/48mmol/mol (symptoms)

6.5%/48mmol/mol
6.5%/48mmol/mol
(no symptoms)
Either
HbA1c

6%/42mmol/mol to
<6.5%/48mmol/mol

Repeat
HbA1c
OGTT

6.5%/
48mmol/
mol

Non-diabetic
hyperglycaemia:
intensive lifestyle
advice

2hr glucose
7.8-11.0mmol/L
2hr glucose
11.1mmol/L

Either
<6%/42mmol/mol

Healthy lifestyle
advice

Diabetes
diagnosis

Yes
7mmol/L (symptoms)
BMI 30 (or 27.5
if Indian, Pakistani,
Bangladeshi, other
Asian or Chinese or
BP 140/90mmHg

7mmol/L (no symptoms)

11.1mmol/L

FPG*
6-7mmol/L
2hr glucose
7.8-11.0mmol/L

No
No further
testing

2hr glucose
OGTT

<6mmol/L

Non-diabetic
hyperglycaemia:
intensive lifestyle
advice
Healthy lifestyle
advice

* The values in the diagram are for laboratory tests. For FPG POCT, use a value of less than 5.5mmol/L
to proceed to healthy lifestyle advice. If the FPG POCT value is 5.5mmol/L or above, repeat using a
venous blood sample for laboratory testing and follow the diagram according to results.

NURSINGSTANDARD / RCNPUBLISHING

(Department of Health 2009)

november 30 :: vol 26 no 13 :: 2011 51

52 november 30 :: vol 26 no 13 :: 2011

Blood sugar test

If at risk

Diabetes filter

BP measurement

Cholesterol test

Body mass index

Ethnicity

Family history

Physical activity

Smoking status

Gender

Age

People recalled to separate

appointments for diagnosis

* Or professionals with suitable patient

information and prescribing rights

All to be undertaken by the

GP practice team

Initially,
primary care
trusts decide
which people
to call first
and where
the checks
can be
accessed
(for example
general
practice and
pharmacy)
bearing in
mind the
need to
tackle health
inequalities

Risk assessment

Cardiovascular disease risk assessment

FIGURE 2

If blood
sugar high

Raised BP

DM

IFG/IGT

Signpost
or refer to
lifestyle
interventions

Serum creatinine

Assessment for
hypertension

CKD assessment

Anti-hypertensives
prescription*

Statins prescription
offered*

IFG/IGT lifestyle
management advice

Weight management
on referral

Exercise on prescription
or other physical
activity intervention

NHS stop smoking

services referral

Behaviour change,
for example Mid-life
LifeCheck

Risk management

eGFR low

High

If CVD risk assessed as >20%

Oral glucose
tolerance test

Risk
assessment

Communication of risk

Vascular checks programme

Recall

Key
BP: blood pressure
CKD: chronic kidney disease
DM: diabetes mellitus
eGFR: estimated glomerular filtration rate
IFG: impaired fasting glucose
IGT: impaired glucose tolerance

Exit
Exit
Exit
Exit
Diabetes High risk Hypertension CKD
register annual
register
register
reviews
(Adapted from Department of Health 2008a)

p48-55w13_A&S Template 25/11/2011 11:59 Page 52

Learning zone cardiology focus

NURSINGSTANDARD / RCNPUBLISHING

p48-55w13_A&S Template 25/11/2011 11:59 Page 53

For those patients already at increased

risk, tools such as QRisk2 will not be
appropriate (Hippisley-Cox et al 2007).
It is important to note any exclusion criteria
for assessment tools. None of the risk
assessment tools, however, advise the
calculation of risk for an individual who
already has vascular disease.
Low (<10%), medium (10-20%) or high
(>20%) risk refers to the individuals risk of
having a heart attack or stroke in the next ten
years (JBS 2005). Table 2 identifies the factors
that are measured to assess overall risk of CVD
as well as to inform actions to be taken.
DH (2009) guidance indicates that it is
not necessary, in the first instance, to
undertake a full range of blood
investigations. However, many GP surgeries
invite patients to have a full range of blood
tests, including liver function, thyroid
function, urea and electrolytes, full blood

count, fasting blood glucose and fasting lipid

profile so that, in the event of the patient
requiring medication, the preliminary tests
have already been completed.
Complete time out activity 4
Risk management
Risk management is a combination of
prescribing, monitoring and evaluating any
appropriate prescription, and likewise
advising, motivating, supporting, monitoring
and evaluating health-related behaviour
changes. The prescription of lipid lowering
therapy (statins) is recommended by NICE
(2008b), Scottish Intercollegiate Guidelines
Network (2007) and JBS (2005) guidelines
for people whose overall CVD risk is greater
than 20%. Secondary causes of
dyslipidaemia, such as type 2 diabetes,
cholestatic liver disease, chronic renal failure,
nephrotic syndrome, hypothyroidism,

4 Using the
information in Table 2,
what BMI would be
classed as obese for a
person of south Asian
ethnic origin? Now list
the factors that might
contribute to obesity
and suggest strategies
or lifestyle modifications
to lower obesity in this
population.

TABLE 2
Factors to consider during cardiovascular disease risk assessment
Data required

Thresholds and additional information

Age

40-74 inclusive.

Gender

Male or female.

Smoking status

Framingham equation (DAgostino et al 2008) smoking or quit within the past year.
QRisk2 smoking or non-smoking (including previous smoker) (Hippisley-Cox et al 2007).

Family history

History of heart attack or stroke in first-degree relative under 60 (included in the QRisk2 not in the
Framingham equation). Joint British Societies (JBS) (2005) guidelines provide an additional calculation
to obtain a score if using the Framingham equation, which is to multiply the score obtained by 1.3.

Ethnicity

QRisk2 incorporates self-assigned ethnicity. The Framingham equation does not include a measure of
ethnicity. The additional calculation suggested by JBS (2005) is to multiply the score obtained by 1.4
if ethnic origin was Indian sub-continent. In the Health Check process, ethnicity such as south Asian
and black minority ethnic groups automatically suggests further testing for the presence of diabetes
since it highly prevalent in those ethnic groups.

Body mass index (BMI)

based on height and
weight measurements

A BMI indicating obesity requires a blood glucose measurement:

4BMI of 27.5 or above in individuals of Indian, Pakistani, Bangladeshi, other Asian and Chinese origins.
4BMI of 30 or above in any other ethnicity.

Cholesterol test

The Framingham equation requires measurement of total serum cholesterol and high density
lipoproteins (HDL). QRisk2 requires the measurement of the total serum cholesterol to HDL ratio.
There are no specific thresholds for total cholesterol for primary prevention, but the National Institute
for Health and Clinical Excellence (NICE) (2008c) and JBS (2005) guidance suggest that a total
cholesterol of >7.0mmols/L or a total cholesterol to HDL ratio of >6 should prompt assessment of
familial hypercholesterolaemia.

Blood pressure (BP)

(systolic and diastolic)

Systolic and diastolic BP measurements are required to ascertain the level of risk from diabetes,
chronic kidney disease and hypertension. If BP is above the threshold (140/90mmHg) then it must
be measured again on two separate occasions by the GP practice team. If BP remains above the
threshold, then the patient will require screening for diabetes and chronic kidney disease. Local
guidelines usually also have an upper safe limit for BP (usually around 180/110mmHg) above which
the patient should be reviewed by a GP immediately.

Physical activity levels

Individuals should aim to engage in 30 minutes of moderate activity, five days a week. NICE (2006
and 2008b) guidance advocates the use of the GP Physical Activity Questionnaire, which measures
levels of physical activity and links this to cardiovascular risk (DH 2006).

NURSINGSTANDARD / RCNPUBLISHING

november 30 :: vol 26 no 13 :: 2011 53

p48-55w13_A&S Template 25/11/2011 11:59 Page 54

Learning zone cardiology focus

smoking and obesity, should be excluded
before statins are commenced.
Treatment of hypertension is recommended
as per the NICE (2011) guidelines. These
guidelines suggest the importance of
confirming hypertension with ambulatory
blood pressure monitoring if possible. If BP
remains 140/90mm/Hg and the CVD risk
calculation gives a risk score of 20% then
antihypertensive treatment should be
commenced. Lifestyle changes, for example
management of weight, smoking and diet
(particularly salt), are effective in reducing
BP, and are recommended alongside
pharmacological treatment.
Behaviour change should also be addressed.
NICE (2007) highlights that there is no single
method that can be universally applied to
influence and change all behaviour. The
healthcare professional should plan to
optimise behaviour change by identifying
resources that can support the patient,
identifying options available for people with
different needs, developing referral pathways
or by developing their own professional skills
and knowledge (Box 1).

Challenges for the future

5 Now that you have
completed the article,
you might like to write
a practice profile.
Guidelines to help you
are on page 60.

To plan and undertake CVD risk assessment

and management is complex. However,
with systematic identification of those at
increased risk and co-ordinated
multidisciplinary delivery of preventive
measures, both pharmacological and
behavioural, can reduce the economic and
personal burden associated with CVD

BOX 1
Methods to help support behaviour change

4Assisting people to develop accurate knowledge about the consequences

of their health-related behaviour.

4Explaining the relevance of health-related behaviour to individual patients.

4Promoting a positive attitude towards the outcome of the change.
4Enhancing peoples beliefs in their ability to make changes.
4Finding a role model to use for illustration of positive health behaviour.
4Where possible, enhancing approval for change within individuals social group.
4Helping people to develop a personal or moral commitment to
behaviour change.

4Assisting people to plan, create and share specific and relevant goals.
4Helping people to anticipate difficulties and challenges associated with
making changes, and preparing them to cope with these.
(National Institute for Health and Clinical Excellence 2007)

54 november 30 :: vol 26 no 13 :: 2011

(Segrott 2009). There are future challenges

to meet to ensure that the services required to
support individuals and communities are
based on up-to-date evidence.
The CVD risk assessment initiative was
not intended to be operating in isolation;
it was supported by work undertaken to
examine effective population strategies to
run in parallel with it. Public health guidance
produced by NICE (2010) advocates a
range of measures that apply to families,
schools, the food industry, local authorities
and health providers. The measures
proposed include legislative changes to
regulate food content and availability,
marketing and promotion, policy changes
to instigate greater health impact
assessment, agricultural policies that
support healthy food production, public
travel, green spaces and those that affect
child and maternal health.
In addition, the guidance specifies that a
CVD assessment and reduction programme
should include the following criteria
(NICE 2010):
4Be sustainable for five years.
4Have clear lines of responsibility and
leadership.
4Be evaluated robustly.
4Be based on local population prevalence
and incidence of CVD.
4Be designed with local people to be sensitive
to their levels of knowledge and awareness
and confidence to be able to make
health-related behaviour changes.
4Work with local policies and provision of
smoking cessation, physical activity and
food teams.
4Identify groups that are at increased risk
of CVD and develop strategies to
address risk.
4Work in partnership with local authorities,
charities, public groups and healthcare
providers.

Conclusion
There are several ways in which primary care
can contribute to the CVD risk assessment
process. It is important to be able to identify
people at high risk of developing CVD.
Everyone in the UK is to some degree at risk
of CVD, and a universal information and
support structure should exist for all.
However, some groups and communities
are at higher risk and will require greater
intervention and effort. It is important to
work with providers outside the clinical arena

NURSINGSTANDARD / RCNPUBLISHING

p48-55w13_A&S Template 25/11/2011 11:59 Page 55

and to ascertain who else is supporting CVD

risk assessment or Health Checks. It is
essential to standardise risk assessment tools,

referral parameters and pathways to ensure

consistency of care for patients NS
Complete time out activity 5

References
Association of Public Health
Observatories (2007) Public Health
Observatories. www.apho.org.uk
(Last accessed: November 11 2011.)
Bhopal R (2000) What is the risk
of coronary heart disease in South
Asians? A review of UK research.
Journal of Public Health. 22, 3,
375-385.
Bovet P (2009) Primary Prevention
of CVD. Ministry of Health,
Seychelles and University of
Lausanne, Switzerland.
Capewell S (2008) Will screening
individuals at high risk of
cardiovascular events deliver large
benefits? No! British Medical
Journal. 337, a1395.
Care Quality Commission (2009)
Closing the Gap: Tackling
Cardiovascular Disease and Health
Inequalities by Prescribing Statins
and Stop Smoking Services. Care
Quality Commission, London.
DAgostino RB, Vasan RS, Pencina MJ
et al (2008) General cardiovascular
risk profile for use in primary care:
the Framingham heart study.
Circulation. 117: 743-753.
Department of Health (2000)
National Service Framework for
Coronary Heart Disease. The
Stationery Office, London.
Department of Health (2001)
National Service Framework
for Diabetes. The Stationery
Office, London.
Department of Health (2005)
National Service Framework for
Renal Services Part Two: Chronic
Kidney Disease, Acute Renal Failure
and End of Life Care. The Stationery
Office, London.
Department of Health (2006) The
General Practice Physical Activity
Questionnaire (GPPAQ). The
Stationery Office, London.
Department of Health (2007)
National Stroke Strategy. The
Stationery Office, London.

Department of Health (2008a)

Putting Prevention First Vascular
Checks: Risk Assessment and
Management. The Stationery Office,
London.

Pedometers and Community-based

Exercise Programmes for Walking
and Cycling. Public Health
Intervention Guidance No. 2.
NICE, London.

Department of Health (2008b)

Putting Prevention First:
Vascular Checks Risk Assessment
and Management Impact
Assessment. The Stationery
Office, London.

National Institute for Health

and Clinical Excellence (2007)
Behaviour Change at Population,
Community and Individual Levels.
Public Health Guidance No. 6.
NICE, London

Department of Health (2009) NHS

Health Check: Vascular Risk
Assessment and Management Best
Practice Guidance. The Stationery
Office, London.

National Institute for Health

and Clinical Excellence (2008a)
Reducing the Rate of Premature
Deaths from Cardiovascular
Disease and other Smoking-Related
Diseases: Finding and Supporting
those most at Risk and
Improving Access to Services.
Public Health Guidance No. 15.
NICE, London.

Department of Health (2010) NHS

Health Check Frequently Asked
Questions. www.healthcheck.nhs.uk/
Library/March_2010_Ebulletin_
FAQs_Final.pdf (Last accessed:
November 11 2011.)
Hanlon P, Venters G (1998)
Scottish Needs Assessment
Programme: Coronary Heart
Disease. Scottish Forum for Public
Health Medicine.
Hippisley-Cox J, Coupland C,
Vinogradova Y, Robson J, May M,
Brindle P (2007) Derivation and
validation of QRISK, a new
cardiovascular disease risk score for
the United Kingdom: prospective
open cohort study. British Medical
Journal. 335, 136. DOI:
10.1136/bmj.39261.471806.55
Jackson R, Wells S, Rodgers A
(2008) Will screening individuals at
high risk of cardiovascular events
deliver large benefits? Yes! British
Medical Journal. 337, a1371.
Joint British Societies (2005) JBS2:
Joint British Societies Guidelines on
prevention of cardiovascular disease
in clinical practice. Heart. 91,
Suppl 5, 1-52.
National Institute for Health and
Clinical Excellence (2006) Four
Commonly Used Methods to
Increase Physical Activity: Brief
Interventions in Primary Care,
Exercise Referral Schemes,

NURSINGSTANDARD / RCNPUBLISHING

National Institute for Health

and Clinical Excellence (2008b)
Lipid Modification: Cardiovascular
Risk Assessment and the
Modification of Blood Lipids for
the Primary and Secondary
Prevention of Cardiovascular
Disease. Clinical Guidance No. 67.
NICE, London.
National Institute for Health
and Clinical Excellence (2008c)
Identification and Management
of Familial Hypercholesterolemia.
Clinical Guideline No. 71. NICE,
London.
National Institute for Health
and Clinical Excellence (2010)
Prevention of Cardiovascular
Disease at Population Level. Public
Health Guidance No. 25. NICE,
London.
National Institute for Health
and Clinical Excellence (2011)
Hypertension: Clinical Management
of Primary Hypertension in Adults.
Clinical Guideline No. 127. NICE,
London.
NHS Health Check (2010) NHS
Health Check Case Studies.
www.healthcheck.nhs.uk/_
CaseStudies.aspx (Last accessed:
November 11 2011.)

ODonnell MJ, Xavier D, Liu L et al

(2010) Risk factors for ischaemic
and intracerebral haemorrhagic
stroke in 22 countries (the
INTERSTROKE study): a
case-control study. The Lancet. 376,
9735, 112-123.
Scottish Intercollegiate Guidelines
Network (2007) Risk Estimation and
the Prevention of Cardiovascular
Disease. SIGN Guideline No. 97.
SIGN, Edinburgh.
Segrott J (2009) Reducing Health
Inequalities: A Primary Care
Approach To Tackling Vascular
Disease http://tiny.cc/AWSRR
(Last accessed: November 11 2011.)
Tunstall-Pedoe H, Woodward M
(2006) By neglecting deprivation,
cardiovascular risk scoring will
exacerbate social gradients in
disease. Heart. 92, 3, 307-310.
UK National Screening Committee
(2008) The Handbook for Vascular
Risk Assessment, Risk Reduction
and Risk Management. University
of Leicester, Leicester.
Welsh Assembly Government
(2010) Vascular Risk Management
in Wales: A Report from the
Vascular Project Group. Welsh
Government, Cardiff.
Woodward M, Brindle P,
Tunstall-Pedoe H (2007) Adding
social deprivation and family
history to cardiovascular risk
assessment: the ASSIGN score
from the Scottish Heart Health
Extended Cohort. Heart. 93, 2,
172-176.
World Health Organization (2009)
The Atlas of Heart Disease and
Stroke. www.who.int/cardiovascular_
diseases/resources/atlas/en
(Last accessed: November 11 2011.)
Yusuf S, Hawken S, Ounpuu S
et al (2004) Effect of potentially
modifiable risk factors associated
with myocardial infarction in 52
countries (the INTERHEART study):
case-control study. The Lancet.
364, 9438, 937-952.

november 30 :: vol 26 no 13 :: 2011 55

p60w13_Practice profile assessment 25/11/2011 10:51 Page 60

Learning zone assessment

Write a practice profile

YOU CAN GAIN A CERTIFICATE OF LEARNING BY READING THIS
LEARNING ZONE ARTICLE AND THEN WRITING A PRACTICE PROFILE
What do I do now?
4 Using the information in the section
below as a guide, write a practice
profile of between 750 and 1,000
words that is related to a learning
zone article. It may help to read this
weeks practice profile on page 59
and In practice below.
4 Write Practice profile at the top
of your entry followed by your
name, the title of the article, which
is Cardiovascular disease risk
assessment, which is NS621.
4 Complete all the fields of the
cut-out form below and attach it
to your practice profile using a
paperclip. Failure to do so will mean
that your practice profile cannot be
considered for a certificate.
4 You are entitled to unlimited free
entries. Using an A4 envelope, send
for your free assessment to: Practice
Profile, RCN Publishing Company,
Freepost PAM 10155, Harrow,
Middlesex HA1 3BR by
November 30 2012. You can
email practice profiles to
practiceprofile@rcnpublishing.
co.uk. You must provide the same
information that is requested on the

cut-out form. Type Practice

profile in the subject field for
confirmation of receipt.
Subscribers can submit profiles at
www.nursing-standard.co.uk by
clicking on the CPD link on the
left-hand side of the homepage.
4 You will be informed of your result
in writing. A certificate is awarded
for successful completion of the
practice profile. You are entitled
to one retake if you are
unsuccessful.
4 Feedback is not provided:
a certificate indicates that you
have been successful. Indicate on
the form if you wish your practice
profile to be considered for
publication in Nursing Standard
(see page 59).
4 Add a copy to your professional
portfolio copies of practice
profiles are not returned.

Framework for reflection

Consider these points before
submitting your practice profile.
4 What have I learned from this article
and how does it relate to my practice?
4 To what extent were intended
learning outcomes met?

4 What knowledge or skills have

I acquired as a result of reading
the article?
4 What can I apply immediately
to my practice or patient care?
4 Is there anything that I did not
understand, need to explore or
read about further, to clarify my
understanding?
4 What else do I need to do/know
to extend my professional
development in this area?
4 What other needs have I identified
in relation to my professional
development?
4 How might I achieve the above?

In practice
After reading a learning zone
article on wound care, Amajit,
a senior staff nurse on a surgical ward,
approached the nurse manager with
concerns about wound infections.
Following an audit, which Amajit
undertook, a protocol for dressing
wounds was established that led to a
reduction in infections on the ward
and across the directorate. Amajit
used this experience for her practice
profile and is now taking part in
a regional research project.

Practice
submission form
form
Practice profile submission
First name:

Number of article:

Surname:

Permanent address:

I would like my practice profile to be

considered for publication in
Nursing Standard:
yes

Job title:

no

Place of work:

Please cut out this form and send it in an

envelope no smaller than A4 size to:
Postcode:

Full title and date of article:

Daytime telephone:

60 november 30 :: vol 26 no 13 :: 2011

Practice Profile
RCN Publishing Company
Freepost PAM 10155
Harrow
Middlesex HA1 3BR

NURSING STANDARD

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.