Cardiovascular disease: identifying and supporting people most at risk of dying early

Appendix D: Gaps in the evidence

PHIAC identified a number of gaps in the evidence relating to the interventions under examination, based on an assessment of the evidence. These gaps are set out below.

1. Interventions that aim to find and treat those most at risk of premature death (and improve their access to services) have rarely been assessed in terms of effectiveness and cost effectiveness.

2. Most studies focus on small scale, local interventions that reflect local context and priorities (for example, drop-in centres for smoking cessation). There is a lack of evidence on the impact of such interventions delivered on a large-scale.

3. There is a lack of evidence on interventions which primarily aim to retain people at risk of specific conditions within the health system, both generally and in relation to characteristics such as age, ethnicity, socioeconomic status and gender.

4. There is a lack of evidence on whether addressing the barriers to service use results in more people using a service.

5. There is a lack of evidence on the impact that combined macro- and micro-level interventions can have on reducing health inequalities and the relative contribution that components at each level make.

6. There is a lack of evidence on the incremental effectiveness and cost effectiveness of adapting interventions to meet the needs of disadvantaged individuals.

7. There is a lack of UK evidence on the effectiveness of using incentives to increase the number of people who both use services and complete their treatment.

(Source: evidence reviews)

The Committee made 5 recommendations for research.