Decision making and risk communication about cardiovascular disease prevention in primary care

Abstract

Background: Use of absolute risk (AR) guidelines for CVD prevention is suboptimal, resulting in over- and under-treatment. The concept of 'heart age' has been suggested to address barriers to AR, but there is little evidence of its efficacy. Aim: Explore GP and patient experiences of CVD risk assessment, management and communication, and experimentally test the effect of 5-year AR compared to blood pressure, cholesterol, and heart age. Methods: Semi-structured interviews with 25 GPs and 38 patients; think aloud study with 26 patients; two experiments with 144 GPs and 570 patients. Results: Medication decision making was influenced by psychosocial and individual risk factors rather than AR guidelines. GPs used subjective risk assessment strategies, had concerns about communicating AR, and did not prescribe medication based on AR even when provided. Patients disregarded heart age calculators if they received unexpected/negative results. Compared to 5-year AR, heart age increased 2-week recall, but did not improve lifestyle, inflated risk perceptions, and decreased positive emotions/credibility. Discussion: This thesis identifies targets for behavioural intervention, and suggests heart age has little benefit over 5-year AR. Capability and motivation barriers need to be addressed amongst GPs and patients to facilitate an evidence-based, shared decision making approach to CVD prevention.