Home self-screening to reduce cardiovascular disease morbidity

‘The hope is first and foremost that screening as a preventive measure will reduce suffering in the population due to serious cardiovascular diseases such as stroke, heart failure, heart attack, vascular disease and kidney disease. In addition, we expect that lower morbidity will reduce the burden on healthcare and save money for society,’ says Johan Sundström, cardiologist at Uppsala University Hospital and Professor of Epidemiology at Uppsala University, who is leading the study together with vascular surgeon Professor Anders Wanhainen.

High blood pressure (hypertension) is a common disease that increases the risk of cardiovascular disease and kidney problems. Blood pressure above 140/90 is a major risk factor for cardiovascular disease and death. Today's medical treatment of hypertension is well proven and effectively reduces the risk of later complications, such as stroke and heart attack, and death. However, the vast majority of people do not recognise their hypertension at all and go untreated. Screening can therefore be a way to identify at-risk individuals at an early stage so that treatment can be initiated for prevention.

The Uppsala Cardiovascular Self-Screening (U-SCREEN) study will start in March 2025 and is expected to run until the end of 2027/beginning of 2028. The researchers will investigate whether self-screening for risk conditions such as high blood pressure, high cholesterol, high blood sugar and low kidney function can reduce the number of serious cardiovascular diseases and thus also reduce costs.

Self-screening at home

People living in Uppsala County, who are 50, 55, 60, 65, 70 or 75 years old, will be randomly selected to receive an offer of self-screening. Those who accept will be sent home with a blood pressure monitor, sampling equipment, and instructions on measuring blood pressure and sampling (a prick of the finger), to carry out the examinations at home. Those who are found to have risk conditions will be invited to contact the U-SCREEN centre at the University Hospital and those who need treatment will be offered it. Participation in the self-screening is completely voluntary.

'We have chosen these groups because the impact of identifying and treating risk conditions is estimated to be greatest in these age groups. When we detect that a participant has values that are considered to be at increased risk, they will be offered support. Drug treatment may be needed if the values are significantly elevated,’ explains Mr Sundström.

According to Sundström, health economic calculations show that for every SEK 1 invested in prevention, SEK 2 to 3 is returned in the form of avoided costs for later disease.

'Several studies of similar screening programmes have been conducted, but their effectiveness is still uncertain and more studies are needed. Randomised clinical trials of this kind are needed before measures are introduced into healthcare. Our hope is that the screening programme we have developed, which uses new methods and is based on citizen participation, is an effective way to improve cardiovascular health in the population,’ he concludes.

The clinical trial is partly financed through health bonds, which involve risk-sharing with an external investor, with the loan being repaid according to the results of the trial under agreed conditions. This way, the region does not bear the financial risk alone.