Communication in cardiovascular disease prevention: How can we make the concept of risk more meaningful?

Introduction: Cardiovascular disease (CVD) prevention guidelines recommendmedication for ‘high risk’ and not ‘low risk’ patients, based ontheir absolute risk of having a heart attack/stroke in the next 5-10 years.GPs report difficulties communicating absolute risk to lower risk patientswhen they want to: 1) motivate lifestyle change; or 2) consider ceasingmedication they are unlikely to benefit from. This study investigated howpatients understand absolute risk.Methods: GPs recruited a purposive sample of 25 patients with at leastone CVD/lifestyle risk factor and varying medication history. Participantswere asked to ‘think aloud’ while using two calculators that display absoluterisk in different but equivalent risk formats (e.g. CVD risk over 5versus 10 years), supplemented with semi-structured interviews.Transcribed audio-recordings were coded using Framework Analysis.Results: Participants understood absolute risk when explained verbally,but found risk category (low/moderate/high) more meaningful than percentagerisk. Comparing current risk to future risk and the effect ofdiet/exercise increased interest in the assessment, particularly the 10-year format as both the risk and effect appeared larger. Those on medicationthought the pre-medication risk assessment was too low to be credible,especially the 5-year format, and the quantified benefit of medicationwas not important to them.Conclusions: GPs and patients may find absolute risk calculators moreuseful when shown over a longer timeframe with risk category, comparisonto future risk, and lifestyle change effects. Low risk patients takingmedication may view it as beneficial regardless of the small chance ofpreventing a CVD event