The effect of giving global coronary risk information to adults: a systematic review

Overview

One of the challenges health care providers face when choosing which preventive services to recommend to patients – and when to recommend them – is the difficulty of identifying patients at risk who would benefit from the services. Various risk assessment tools are available to health care providers, including the Framingham risk score and the UK Prospective Diabetes Study risk score. These tools can be cumbersome, however, and are not always used in the clinical setting. The authors of this review article evaluated whether providing patients with an estimation of their cardiovascular disease risk, using one or more of the available risk assessment tools, helped improve their understanding of their own health risks, increased their desire to initiate appropriate therapy, and led to any reduction of their personal cardiovascular risk factors. The authors found that there is a benefit to patients receiving personalized information on heart attack risk. An underlying concept is that expensive and potentially harmful therapies should only be used in those patients who stand to gain the most benefits.

Methodology

The authors systematically reviewed twenty articles related to cardiovascular risk assessment and patient education, including eleven randomized controlled trials. Six articles were judged to be of good quality, twelve of fair quality and two less than fair. Several different cardiovascular risk assessment tools were used, but all of the articles incorporated some risk assessment tool to educate patients on their individual risk.

Results

  • A systematic review of these articles suggested that providing patients with an estimate of their global cardiovascular risk increased patient understanding of their individual risk by approximately 10% and increased patient interest in starting appropriate treatment by approximately 15-20%.

  • Of the studies that evaluated patients and their individual cardiovascular risk assessments over time, direct patient counseling about individual risk decreased the predicted 10-year cardiovascular risk by a small amount.

Conclusions

  • There is a measureable benefit to patients receiving personalized information on heart attack risk. The authors conclude that health care providers should incorporate some form of cardiovascular risk assessment in patient education, as it improves patients’ understanding of their own risks, increases their interest in starting appropriate treatment, and may decrease their cardiovascular risk over time. Providing patients with an estimate of their global cardiovascular risk increased patient understanding of their individual risk by approximately 10% and increased patient interest in starting appropriate treatment by approximately 15-20%.

  • Best practices around the delivery of personalized risk information to patients should include:

    • More intensive interventions to present risk information (for example, longer face-to-face visits) as these have greater impacts. Risk information must be combined with other strategies aimed at improving therapies and changing behaviors.

    • Information should be presented with the goal of presenting information in literacy appropriate language.