I don't believe it, but I'd better do something about it: patient experiences of online 'heart age' risk calculators

Abstract

Background: Health risk calculators are widely available on the internet, including cardiovascular disease (CVD) risk calculators that estimate the probability of a heart attack, stroke or death over a 5 or 10 year period. Some calculators convert this probability to 'heart age', where older heart age than current age indicates modifiable risk factors. These calculators may impact patient decision making about CVD risk management with or without clinician involvement, but little is known about how patients use them. Objectives: This study aimed to investigate patient experiences and understanding of online heart age calculators based on the Framingham Risk Equation used in clinical guidelines around the world. Methods: General Practitioners in New South Wales, Australia recruited 26 patients with CVD/lifestyle risk factors who were not taking cholesterol or blood pressure-lowering medication in 2012. Participants were asked to ‘think aloud’ while using two heart age calculators in random order, with semi-structured interviews before and after. Transcribed audio-recordings were coded and a Framework Analysis method was used. Results: Risk factor questions were often misinterpreted, reducing the accuracy of the calculators. Participants perceived older heart age as confronting, and younger heart age as positive but unrealistic. Unexpected or contradictory results (e.g. low percentage risk but older heart age) led participants to question the credibility of the calculators. Reasons to discredit the results included the absence of relevant lifestyle questions and impact of corporate sponsorship. However, the calculators prompted participants to consider lifestyle changes irrespective of whether they received younger, same or older heart age results. Conclusions: Online heart age calculators can be misunderstood and disregarded if they produce unexpected or contradictory results, but they may motivate lifestyle change anyway. Future research should investigate both the benefits and harms of communicating risk in this way, and how to increase the reliability and credibility of online health risk calculators.