Communicating lifetime risk of cardiovascular disease (CVD) to patients at high risk has a greater influence on how risk is perceived than short-term estimates of risk. Furthermore, perceived risk is correlated with willingness for therapy.
These findings can help clinicians better engage patients in decision-making regarding preventive strategies, said Ann Marie Navar, MD, PhD, an assistant professor of medicine at Duke, who presented the results of the study at the Scientific Sessions of the American Heart Association held November 12 to 16, 2016, in New Orleans, LA. Tracy Y. Wang, MD, Pearl Zakroysky, MPH, Shuang Li, MS, and Eric D. Peterson, MD, from Duke were also involved in the study.
Better engagement of patients is essential with the continuing shift toward shared decision-making, which is highlighted in guidelines that note the importance of clinicians discussing with patients the potential CVD risk-reduction benefits of statin therapy. However, the optimal format for communicating CVD risk is unclear.
Several websites are available to help determine risk, but these sites are “calculators, not communication aids,” said Navar.
The study was designed to address 2 questions:
- How does the horizon of risk affect perceived risk severity and willingness to engage in therapy?
- How does the way risk is displayed influence patients’ interpretation of risk?
Included in the study were 3,060 patients from the Patient and Provider Assessment of Lipid Management registry, a cross-sectional database of patients at risk for CVD or with prior CVD seen across 138 cardiology, endocrinology, and primary care clinics in the United States between May and September 2015.
Three scenarios representing the same risk but across different horizons of risk were presented to all participants:
- 10-year risk of 15%
- Lifetime risk of 50%
- 10-year risk of death of 4%
The participants were randomly assigned to receive the risk scenario as a pictogram (100 smile/frown faces), as a bar graph, or with no graphic and then were asked to rate how high they perceived the risk to be. Responses were compared by risk horizon and format.
Participants were more likely to report that they perceived the risk as “high or very high” when presented with lifetime CVD risk (73%) than with 10-year CVD risk (32%; P < .001 vs lifetime risk) or CVD risk of death (26%; P < .001 vs lifetime risk). When risk was presented as a pictogram, perceptions of risk were lower than when it was presented as a bar graph or without a graphic.
For example, 22% of participants perceived the 10-year risk was “high or very high” with a pictogram compared with 36% and 37% of participants who were presented with a bar graph or with no graphic, respectively. Similarly, the perceived risk was lower for the pictogram with regard to lifetime risk (66%) than for the bar graph or no graphic (75% for each).
“Small changes in how we present risk, such as the type of graphic used, can have significant impact on how our patients interpret risk and their potential willingness to engage in risk-reduction therapies,” Navar said.
She hypothesized that participants most likely perceived the lifetime risk as highest because of the high associated percentage.
“As a cardiologist and researcher, I know that a 10-year risk of MI or stroke of 15% is high, but most participants did not perceive that as high risk. So we may be thinking we are telling our patients one thing, but they are hearing something completely different. We need to determine how to communicate risk that accurately reflects our qualitative assessment of the severity of that risk.”
Source: Navar AM, Wang TY, Zakroysky P, et al. Impact of communication format and risk horizon on patient perceptions of CVD risk: findings from the PALM registry. Presented at: American Heart Association Scientific Sessions 2016; November 12-16, 2016; New Orleans, LA. Abstract 781.