Perceptions of cardiovascular risk among patients with hypertension or diabetes

Knowledge about cardiovascular diseases in a first-level healthcare center in Lima, Peru

BACKGROUND

Motivation for the study. In Peru, the knowledge level of patients about their cardiovascular health is unknown at the first level of care, which receives 85% of the population, and where primary disease prevention activities are carried out.

BACKGROUND

Main findings. More than 70% of people had an inadequate level of knowledge about their own cardiovascular health.

BACKGROUND

Implications. Our results highlight the need to improve the education of people on cardiovascular health issues at the first level of care, taking into account that these diseases are increasingly frequent in the population.

BACKGROUND

This study aimed to determine the level of knowledge about cardiovascular diseases in people in a primary healthcare center (PHCC). A descriptive and cross-sectional study was carried out by surveying people who attended a PHCC in Lima, Peru. A score less than 6 was considered inadequate knowledge. A total of 400 people were surveyed, 66.3% were women and the mean age was 46.8 ± 16.2 years. The average score was 4.52 +/- 1.85. We found that 71% of those surveyed had an inadequate level of knowledge, regardless of age, gender or education level. Our findings show that the level of knowledge about risk factors and cardiovascular disease was inadequate in the primary care population. It is necessary to achieve proper specific education in cardiovascular risk factors in order to reduce the impact of these diseases.

Exploring the content and delivery of feedback facilitation co-interventions: a systematic review

BACKGROUND

Policymakers and researchers recommend supporting the capabilities of feedback recipients to increase the quality of care. There are different ways to support capabilities. We aimed to describe the content and delivery of feedback facilitation interventions delivered alongside audit and feedback within randomised controlled trials.

METHODS

We included papers describing feedback facilitation identified by the latest Cochrane review of audit and feedback. The piloted extraction proforma was based upon a framework to describe intervention content, with additional prompts relating to the identification of influences, selection of improvement actions and consideration of priorities and implications. We describe the content and delivery graphically, statistically and narratively.

RESULTS

We reviewed 146 papers describing 104 feedback facilitation interventions. Across included studies, feedback facilitation contained 26 different implementation strategies. There was a median of three implementation strategies per intervention and evidence that the number of strategies per intervention is increasing. Theory was used in 35 trials, although the precise role of theory was poorly described. Ten studies provided a logic model and six of these described their mechanisms of action. Both the exploration of influences and the selection of improvement actions were described in 46 of the feedback facilitation interventions; we describe who undertook this tailoring work. Exploring dose, there was large variation in duration (15-1800 min), frequency (1 to 42 times) and number of recipients per site (1 to 135). There were important gaps in reporting, but some evidence that reporting is improving over time.

CONCLUSIONS

Heterogeneity in the design of feedback facilitation needs to be considered when assessing the intervention's effectiveness. We describe explicit feedback facilitation choices for future intervention developers based upon choices made to date. We found the Expert Recommendations for Implementing Change to be valuable when describing intervention components, with the potential for some minor clarifications in terms and for greater specificity by intervention providers. Reporting demonstrated extensive gaps which hinder both replication and learning. Feedback facilitation providers are recommended to close reporting gaps that hinder replication. Future work should seek to address the 'opportunity' for improvement activity, defined as factors that lie outside the individual that make care or improvement behaviour possible.

REVIEW REGISTRATION

The study protocol was published at: https://www.protocols.io/private/4DA5DE33B68E11ED9EF70A58A9FEAC02 .

Research progress in stroke risk perception assessment tool

BACKGROUND

One of the main illnesses in the globe that causes impairment and death in people is stroke. In the globe today, it ranks as the second leading cause of death and the leading cause of death in China.

OBJECTIVE

This paper analyses into the critical role of risk perception in developing individual awareness of stroke risk and encouraging proactive preventive health behaviors, essential for effective primary stroke prevention strategies and reduced stroke incidence. It discusses the concept of risk perception, the content and dimensions of global stroke assessment tools, and their application status, aiming to provide insights for their development and intervention research.

METHODS

Risk perception encompasses subjective assessments of stroke likelihood and severity, influenced by personal experiences, knowledge of risk factors, beliefs about prevention effectiveness, and emotional responses. Global stroke assessment tools, like the Framingham Stroke Risk Score and CHA2DS2-VASc Score, evaluate stroke risk based on factors such as age, gender, blood pressure, and cholesterol levels. In order to improve risk perception and proactive health management and lower the burden of strokes, the paper assesses the advantages and disadvantages of these tools and makes recommendations for improving accessibility, customizing interventions, running educational campaigns, promoting multidisciplinary collaboration, and integrating technology.

RESULTS

By combining the research tools of stroke risk perception, it is found that the evaluation tools are mostly single-dimensional evaluation tools centered on the two dimensions of onset possibility and susceptibility.

CONCLUSION

Some scholars have developed multi-dimensional evaluation tools, but the evaluation population is relatively limited, and the evaluation system lacks comprehensiveness and systematization.

Cardiovascular disease risk perceptions and influencing factors among Chinese systemic lupus erythematosus patients

BACKGROUND

Systemic Lupus Erythematosus patients (SLE) are at a higher risk of cardiovascular events than the general population. This study aimed to investigate the risk perception of cardiovascular disease (CVD) and to analyze its influence factors among Chinese SLE patients.

METHODS

This was a cross-sectional study. Convenience sampling was used to select 201 patients with SLE who had attended the outpatient and inpatient departments of the Department of Rheumatology and Immunology at the First Affiliated Hospital of the University of Science and Technology of China from November 2022 to March 2023. The following were used in the study: the Chinese version of the Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire, the Social Support Rating Scale, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Health Literacy Management Scale, and sociodemographic and disease-related data.

RESULTS

The mean (standard deviation) risk perception score of CVD patients with SLE was 57.18 ± 13.02. A Pearson correlation analysis showed that CVD risk perceptions were positively correlated with health literacy (r = 0.152, p < .05) and depression (r = 0.277, p < .05), and negatively correlated with social support (r = -0.393, p < .05) and psychological resilience (r = -0.374, p < .05). A multiple linear regression analysis showed that body mass index (BMI), family history, health literacy, depression, social support, and psychological resilience were the main factors influencing CVD risk perceptions among Chinese SLE patients (p < .05).

CONCLUSIONS

Body mass index, family history, health literacy, depression, social support, and psychological resilience influenced CVD risk perceptions among Chinese SLE patients. Healthcare workers should objectively and accurately assess the levels of CVD risk perception among SLE patients, identify the risk factors of CVD, adopt effective health risk communication strategies to help patients develop appropriate risk perceptions, and raise risk awareness to adopt active coping approaches to reduce risk.

Perception of recurrent risk versus objective measured risk of ischemic stroke in first-ever stroke patients from a rural area in China: A cross-sectional study

OBJECTIVE

Risk perception is critical to the formation of individual health prevention behaviors. A long-term accurate perception of stroke recurrent risks is imperative for stroke secondary prevention. This study aims to explore the level of recurrence risk perceptions and the influential factors of inaccuracy between perceived and objective risk in first-ever ischemic stroke patients from a rural area.

METHODS

From May to November 2020, 284 first-ever ischemic stroke patients were conveniently recruited in a rural area of Henan Province, China. Perceived risk was measured based on self-reported using a numerical rating scale, whereas the objective risk was measured by the Essen Stroke Risk Score. Patients' perceived risk was compared with their objective risk and categorized as "Accurate," "Underestimated," and "Overestimated." The influencing factors of inaccuracy were further evaluated using multivariate regression analyses.

RESULTS

46% of the participants underestimated their stroke risk, while 15.9% overestimated their risks. Patients who were younger (≤65 years), didn't worry about recurrent stroke, and had a low actual recurrent risk were more likely to underestimate their recurrent risk. Patients who were employed, had lower independence, and had greater anxiety were more likely to overestimate their recurrent risk.

CONCLUSIONS

The majority of participants were unable to accurately perceive their own risk of stroke recurrence. Patients' age, working status, worry about recurrent stroke, actual recurrent risk, level of dependence, and anxiety played a role in perception inaccuracy.

PRACTICE IMPLICATIONS

The findings could help healthcare providers gain a better understanding of the level and accuracy of recurrence risk perceptions among first-ever stroke patients in the rural area. Future counseling on the perceived risk of stroke recurrence and individual objective risk assessment could be conducted to help patients better understand their risk of recurrence. Individualized risk communication and multidisciplinary teamwork can be developed to improve the accuracy of recurrence risk perceptions and health behaviors.

Low Subjective Cardiovascular Disease Risk Perceptions among Hypertensive Patients in Addis Ababa, Ethiopia

Background

Accurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients’ risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS).

Methods

A cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants’ risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level.

Results

Participants (n=377) had a mean age of 53.61 ± 12.80-years, range (18–82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43–18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36–14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants’ CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation.

Conclusion

Hypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients’ CVD risk perception to reduce adverse CVD events.

Validation of the French Cues to CPAP Use Questionnaire in patients with OSAS: A step forward for evaluating cues to CPAP use in order to predict treatment adherence

PURPOSE

The cues to starting CPAP are important in patients with Obstructive Sleep Apnea Syndrome (OSAS) to predict CPAP use and behavioral change. The Cues to CPAP Use Questionnaire (CCUQ) is a short practical self-reported scale to evaluate such cues to action. This study sought to examine the psychometric reliability and validity of the French version.

METHODS

A forward-backward translation of the CCUQ was performed. Principal research tools were CCUQ, SEMSA and ESS. Subjects with OSAS were invited to complete the CCUQ just before CPAP initiation and 10 days after CPAP initiation. The ESS was completed just before CPAP initiation and one month after CPAP initiation. The SEMSA was completed just before CPAP initiation. Statistical analyses methods aim to evaluate the psychometric properties of the French CCUQ version in terms of its construct validity, internal structural validity, test-retest and external validity. Mean CPAP use on the previous month was recorded at one, six and twelve months after CPAP initiation.

RESULTS

A total of 140 patients with OSAS were included with 61.4% of men and a mean age of 55.3 (±12.9), BMI of 29.8 (±4.9), initial ESS of 11.97 (±5.68), and initial AHI 37.2/h (±19.3). Factor analysis confirmed the three-factor structure of the CCUQ. Cronbach's alpha coefficient was 0.64. Test-retest reliability (at t-0 and at 10 days) of the CCUQ was satisfactory. External validity shown significant correlation of the CCUQ with SEMSA and of the dimension "Partner cues" of the CCUQ with mean CPAP use at one month.

CONCLUSION

The French CCUQ scale is a reliable and valid tool for measuring cues to action in adults with OSAS initiating CPAP treatment. Further studies are necessary to confirm the predictive value of cues to action and self-efficacy for CPAP use and adherence. Such investigations would underpin public health CPAP interventions in accordance with models of behavioral change.

40-65 Yaş Erkeklerin Gerçek ve Algıladıkları Kardiyovasküler Hastalık Risklerinin Karşılaştırılması: Bir Kesitsel Çalışma

Objective: To determine the actual cardiovascular diseases risk and to compare it with the perceived risk in 40-65 years old men. Methods: We conducted a cross-sectional study in a population determined to be 21.039 men and sample consisted of 400 men. The actual cardiovascular diseases risks of these respondents were calculated using HeartScore, classified as low, moderate, high, or very high. The respondents’ perception of their cardiovascular disease’s risks was categorized as wrong optimists/pessimists and realists. We used multivariate logistic regression models to determine the relationships between perceived cardiovascular diseases risk and independent variables (age, diabetes, hypertension, etc.). Required ethics committee and institutional permissions were obtained for the duly conduct of the study. Results: It was determined in our study that while 8.3% (n=33) of the men had a high-risk level for cardiovascular disease, 52.5% (n=210) had a very high level. Forty-eight percent of the participants perceive their CVD risks to be lower than they are and 23.8% to perceive it higher than they are. Correct estimation rate of CVD risk was 28.2%. The variables affecting the actual cardiovascular diseases risk were diastolic blood pressure, body mass index, and level of physical activity. 13.3% (n=53) of respondents perceived their cardiovascular diseases risks as high and 8% (n=32) as very high. The variables affecting an incorrect perceived cardiovascular diseases risk are being 61-65 years of age (odds ratio=0.34, 95% confidence interval: 0.16-0.73) and a diagnosis of diabetes mellitus (odds ratio=0.45, 95% confidence interval: 0.20-0.99). Conclusion: We observed that more than half of the residents were at a very high level of risk for cardiovascular disease, and approximately one out of every two respondents perceived their risk of cardiovascular disease to be lower than the actual risk. It is recommended risk reducing behaviors be developed and awareness of risk be raised.

Factors associated with antihypertensive monotherapy among US adults with treated hypertension and uncontrolled blood pressure overall and by race/ethnicity, National Health and Nutrition Examination Survey 2013-2018

BACKGROUND

Treating hypertension with antihypertensive medications combinations, rather than one medication (ie, monotherapy), is underused in the United States, particularly in certain race/ethnic groups. Identifying factors associated with monotherapy use despite uncontrolled blood pressure (BP) overall and within race/ethnic groups may elucidate intervention targets in under-treated populations.

METHODS

Cross-sectional analysis of National Health and Nutrition Examination Surveys (NHANES; 2013-2014 through 2017-2018). We included participants age ≥20 years with hypertension, taking at least one antihypertensive medication, and uncontrolled BP (systolic BP [SBP] ≥ 140 mmHg or diastolic BP [DBP] ≥ 90 mmHg). Demographic, clinical, and healthcare-access factors associated with antihypertensive monotherapy were determined using multivariable-adjusted Poisson regression.

RESULTS

Among 1,597 participants with hypertension and uncontrolled BP, age- and sex- adjusted prevalence of monotherapy was 42.6% overall, 45.4% among non-Hispanic White, 31.9% among non-Hispanic Black, 39.6% among Hispanic, and 50.9% among non-Hispanic Asian adults. Overall, higher SBP was associated with higher monotherapy use, while older age, having a healthcare visit in the previous year, higher body mass index, and having heart failure were associated with lower monotherapy use.

CONCLUSION

Clinical and healthcare-access factors, including a healthcare visit within the previous year and co-morbid conditions were associated with a higher likelihood of combination antihypertensive therapy.

What CVD risk factors predict self-perceived risk of having a myocardial infarction? A cross-sectional study

Background

This study aims to identify predictors of self-perceived risk of myocardial infarction (MI).

Methods

Among 564 men and women (50–65 years; randomly selected from the Swedish population), we assessed risk perception as relative self-perceived risk compared to others (lower, same, higher) and percentage ten-year absolute risk. Predictors (added blockwise) were identified using multinomial or linear regression, providing odds ratios (ORs) or β coefficients with their 95% confidence intervals (CI).

Results

The mean of self-perceived 10-year MI risk was 12%. Lower BMI (AOR 0.57, 95% CI: 0.44–0.75), low stress (AOR 2.51, 95% CI: 1.39–4.52), high level of physical activity (AOR 1.66, 95% CI:1.01–2.74), hypertension (AOR 0.42, 95% CI: 0.23–0.76), family history (AOR 0.38, 95% CI: 0.21–0.69), and poor general health (AOR 0.41, 95% CI: 0.19–0.89) predicted if respondents perceived their MI risk as lower. Poor general health (AOR 1.94, 95% CI: 1.01–3.73), family history (AOR 2.72, 95% CI: 1.57–4.72), and high cholesterol (AOR 2.45, 95% CI: 1.18–5.09) predicted if respondents perceived their MI risk as higher. Low level of self-perceived CVD knowledge and low numeracy predicted if respondents perceived their MI risk as the same as others. High cholesterol (B 6.85, 95% CI: 2.47–11.32) and poor general health (B 8.75, 95% CI: 4.58–13.00) predicted a higher percentage of perceived ten-year risk.

Conclusion

General health was a common predictor of self-perceived MI risk. Lifestyle factors (BMI, physical activity) and stress dominated the predictors for perceiving MI risk as lower than others, while high cholesterol predicted perception of high risk.

Good general health and lack of family history influence the underestimation of cardiovascular risk: a cross-sectional study

AIMS 

Underestimation of cardiovascular risk may interfere with prevention of cardiovascular diseases (CVDs). We investigate whether general health and family history of myocardial infarction (MI) are associated with underestimation of perceived cardiovascular risk, and if the participants' calculated risk modifies that association.

METHODS AND RESULTS 

The analysis sample consisted of 526 individuals, 50-64 years old, from a population-based cohort study. Information on general health (poor/fairly good, good, and very good/excellent), family history of MI, and self-perceived risk relative to others of similar age and sex were collected though a web-based survey. Participants were categorized into underestimation (n = 162, 31%), accurate estimation (n = 222, 42%), and overestimation (n = 142, 27%) of cardiovascular risk by comparing calculated Systematic Coronary Risk Estimation (SCORE) with self-perceived risk. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for underestimation vs. accurate estimation of cardiovascular risk were computed using logistic regression (n = 384). Very good general health (OR 2.60, 95% CI 1.10-6.16) and lack of family history (OR 2.27, 95% CI 1.24-4.18) were associated with underestimation of cardiovascular risk. The associations were modified by the participants' calculated risk level; the association was stronger for high-risk individuals; without family history OR 22.57 (95% CI 6.17-82.54); with very good/excellent health OR 15.78 (95% CI 3.73-66.87).

CONCLUSION 

A good general health and the lack of family CVD history can obscure the presence of other risk factors and lead to underestimation of cardiovascular risk, especially for high-risk individuals. It is, therefore, crucial to address the fact that the development of CV disease may be silent and multifactorial.

Awareness of heart disease and associated health behaviours in a developing country: a qualitative study

AIM

The aim of this study was to explore awareness of heart disease and associated health behaviours.

DESIGN

A qualitative study was conducted using in-depth interviews.

METHODS

The study participants were patients with hypertension. Data analysis was guided by Braun and Clarke's steps of thematic analysis and using NVivo12 software.

RESULTS

A total of 18 patients with hypertension were interviewed. The patients had poor understanding of heart disease and were not concerned about developing heart disease in the future. Barriers to fruit and vegetable consumption were poor access, cost and sociocultural factors, whereas being busy, poor physical health and lack of access to an exercise facility were barriers to physical activity.

A latent profile analysis of the link between sociocultural factors and health-related risk-taking among U.S. adults

BACKGROUND

Research suggests that health/safety behaviors (e.g., drinking heavily) and medical behaviors (e.g., donating blood) may be perceived as inherently risky, and further suggests there is substantial variation in the likelihood of engaging in a particular health-related risk behavior across people. Research examining demographic and sociocultural factors related to both health/safety and medical risk-taking is highly limited. Importantly, with very few exceptions the literature examining health risks characterized by potentially hazardous health behaviors (e.g, heavy alcohol use, driving without a seatbelt) is kept separate from the literature examining health risks characterized by potentially beneficial medical behaviors (e.g., donating blood, taking medication). In the interest of health promotion, it is critical for researchers to identify - and describe - individuals who are less inclined to engage in health-harming behaviors while at the same time being more inclined to engage in health-benefiting behaviors. Identifying such a subtype of individuals was the guiding aim for this study.

METHOD

A national sample of adults in the United States responded to a survey on sociocultural and demographic correlates of health behaviors. Health-related risk-taking indicators were measured using the items from the health/safety and medical subscales of the DOSPERT-M. Subtypes of risk-takers were identified using latent profile analysis (LPA). Follow-up analyses to describe subtype demographic characteristics were conducted.

RESULTS

LPA identified four subtypes of risk-takers, including a subtype (n = 565, 45% of the sample; labeled "divergent") that was comprised of individuals who highly endorsed medical risk-taking (e.g., taking medicine, giving blood) and minimally endorsed health/safety risk-taking (e.g., drinking heavily, unprotected sex). Subsequent analyses suggested that, among other findings, divergent profile members were likely to be married, endorse familial interdependence, and orient toward masculinity rather than femininity.

CONCLUSION

By examining potentially modifiable factors related to individuals' inclinations to engage in health protective behaviors, this study is an important step toward improving current health behavior interventions among U.S. adults.

Coronary artery calcium scoring: an evidence-based guide for primary care physicians

Primary care physicians often must decide whether statin therapy would be appropriate (in addition to lifestyle modification) for managing asymptomatic individuals with borderline or intermediate risk for developing atherosclerotic cardiovascular disease (ASCVD), as assessed on the basis of traditional risk factors. In appropriate subjects, a simple, noninvasive measurement of coronary artery calcium can help clarify risk. Coronary atherosclerosis is a chronic inflammatory disease, with atherosclerotic plaque formation involving intimal inflammation and repeated cycles of erosion and fibrosis, healing and calcification. Atherosclerotic plaque formation represents the prognostic link between risk factors and future clinical events. The presence of coronary artery calcification is almost exclusively an indication of coronary artery disease, except in certain metabolic conditions. Coronary artery calcification can be detected and quantified in a matter of seconds by noncontrast electrocardiogram-gated low-dose X-ray computed tomography (coronary artery calcium scoring [CACS]). Since the publication of the seminal work by Dr. Arthur Agatston in 1990, a wealth of CACS-based prognostic data has been reported. In addition, recent guidelines from various professional societies conclude that CACS may be considered as a tool for reclassifying risk for atherosclerotic cardiovascular disease in patients otherwise assessed to have intermediate risk, so as to more accurately inform decisions about possible statin therapy in addition to lifestyle modification as primary preventive therapy. In this review, we provide an overview of CACS, from acquisition to interpretation, and summarize the scientific evidence for and the appropriate use of CACS as put forth in current clinical guidelines.

Mismatch between self-perceived and calculated cardiometabolic disease risk among participants in a prevention program for cardiometabolic disease: a cross-sectional study

Background

The rising prevalence of cardiometabolic diseases (CMD) calls for effective prevention programs. Self-assessment of CMD risk, for example through an online risk score (ORS), might induce risk reducing behavior. However, the concept of disease risk is often difficult for people to understand. Therefore, the study objective was to assess the impact of communicating an individualized CMD risk score through an ORS on perceived risk and to identify risk factors and demographic characteristics associated with risk perception among high-risk participants of a prevention program for CMD.

Methods

A cross-sectional analysis of baseline data from a randomized controlled trial conducted in a primary care setting. Seven thousand five hundred forty-seven individuals aged 45–70 years without recorded CMD, hypertension or hypercholesterolemia participated. The main outcome measures were: 1) differences in cognitive and affective risk perception between the intervention group - who used an ORS and received an individualized CMD risk score- and the control group who answered questions about CMD risk, but did not receive an individualized CMD risk score; 2) risk factors and demographic characteristics associated with risk perception.

Results

No differences were found in cognitive and affective risk perception between the intervention and control group and risk perception was on average low, even among high-risk participants. A positive family history for diabetes type 2 (β0.56, CI95% 0.39–0.73) and cardiovascular disease (β0.28, CI95% 0.13–0.43), BMI ≥25 (β0.27, CI95% 0.12–0.43), high waist circumference (β0.25, CI95% 0.02–0.48) and physical inactivity (β0.30, CI95% 0.16–0.45) were positively associated with cognitive CMD risk perception in high-risk participants. No other risk factors or demographic characteristics were associated with risk perception.

Conclusions

Communicating an individualized CMD risk score did not affect risk perception. A mismatch was found between calculated risk and self-perceived risk in high-risk participants. Family history and BMI seem to affect the level of CMD risk perception more than risk factors such as sex, age and smoking. A dialogue about personal CMD risk between patients and health care professionals might optimize the effect of the provided risk information.

Trial registration

Dutch trial Register number NTR4277, registered 26th Nov 2013.

The EMPOWER-SUSTAIN e-Health Intervention to improve patient activation and self-management behaviours among individuals with Metabolic Syndrome in primary care: study protocol for a pilot randomised controlled trial

Background

Epidemiological studies conducted in various parts of the world have clearly demonstrated that metabolic syndrome (MetS) is an increasing global health problem, not only in Western societies but also in Asian populations. Web-based and mobile phone-based self-management applications have been proven to be effective in improving self-management behaviour of patients with MetS components (i.e., diabetes or hypertension). However, evidence is lacking in terms of their effectiveness specifically for patients with MetS. The aim of this pilot study is to evaluate the feasibility and potential effectiveness of the EMPOWER-SUSTAIN Self-Management e-Health Intervention in improving activation and self-management behaviours among patients with MetS. This paper presents the study protocol.

Methods

A pilot randomised controlled trial will be conducted in a university primary care clinic. A total of 232 patients aged 18–60 years with MetS will be recruited; 116 will be randomised to receive the EMPOWER-SUSTAIN intervention for 6 months, and another 116 patients will continue with usual care. The EMPOWER-SUSTAIN intervention is a multifaceted chronic disease management strategy based on the Chronic Care Model and persuasive technology theory. It consists of training primary care physicians, nurses and patients to use the EMPOWER-SUSTAIN web-based self-management mobile app, strengthening the patient–physician relationship and reinforcing the use of relevant clinical practice guidelines to guide management and prescribing. The primary outcome is the mean change in patient activation score using the Patient Activation Measure short form Malay version (PAM-13-M) questionnaire. The secondary outcomes include the changes in waist circumference, body mass index, blood pressure, patient physical activity level, eating behaviour, perception of chronic illness care, satisfaction with patient–physician interaction, and perceived absolute 10-year cardiovascular disease risk. Feasibility of implementing the intervention will be evaluated. This includes acceptability of the intervention, estimating the likely rate of participant recruitment and retention, appropriateness of the outcome measures, calculation of sample size, and the intervention’s potential effectiveness.

Conclusion

To our knowledge, this is the first study in Malaysia that aims to determine the feasibility of a multifaceted e-health intervention, as well as to indicate more useful aspects of this intervention for further exploration in a larger trial.

Trial registration

ClinicalTrials.gov, NCT04120779. Registered on 9 October 2019, protocol version 1.

Socioeconomic status and self-rated health in China: Findings from a cross-sectional study

To investigate whether socioeconomic status is associated with the self-rated health (SRH) status among Chinese.A cross sectional study including a national sample was conducted among Chinese adults in 2008. In total, 3225 participants were selected by a multistage cluster sampling method. Both general self-rated health and time-comparative self-rated health were measured by a standardized questionnaire. Logistic regression models were used to estimate the odds ratios (ORs) (95% confidence intervals, CIs) of occupation with SRH by occupation, and adjusted for age, sex, education, area, marriage, smoking, drinking, and health status.Overall, 34.4% of study participants reported "good" on the general SRH (male: 35.8%; female: 32.9%) and 26.2% reported "good" on the time-comparative SRH (male: 27.2%; female: 25.3%). The prevalence of "good" general SRH varied from 28.8% to 52.8% and the prevalence of time-comparative SHR varied from 21.7% to 33.9% in different occupations. The adjusted OR (Odd Ratio) for "good" on the general SRH was 1.35 (95% CI: 1.20-1.52) for the occupation of civil servants, 2.23 (95% CI: 1.96-2.54) for farmers, and 1.15 (95%CI: 1.01-1.31) for businessmen. The full adjusted OR of "good" on the time-comparative SRH was 1.36 (95% CI: 1.17-1.58) for students and was 1.25 (95% CI: 1.10-1.42) for civil servants.In presented study, 34.4% of the participants reported "good" on the general SRH, and 26.2% participants reported "good" on the time-comparative SRH. The prevalence of "good" general SRH and "good" time-comparative SRH varied among occupations.

Measurement and Outcomes of the Perceived Risk of Stroke: A Review

Stroke continues to be a public health problem, and risk perceptions are key to understanding people's thoughts about stroke risk and their preventive health behaviors. This review identifies how the perceived risk of stroke has been measured and outcomes in terms of levels, predictors, accuracy, and intervention results. Sixteen studies were included. The perceived risk of stroke has primarily been assessed with single-item measures; no multi-item surveys were found. In general, people tend to perceive a low-moderate risk of stroke; the most common predictors of higher stroke risk perceptions were having risk factors for stroke (hypertension, diabetes) and a higher number of risk factors. However, inaccuracies were common; at least half of respondents underestimated/overestimated their risk. Few studies have examined whether interventions can improve the perceived risk of stroke. Strategies to improve stroke risk perceptions should be explored to determine whether accuracy can promote healthy lifestyles to reduce stroke risk.

Health perception in menopausal women

AIM

The aim of this study is to find whether the worsening of health perception was related to the menopausal (MNP) state or to its negative consequences on cardiometabolic risk factors (CMRF) and the presence of depression/anxiety.

METHODS

In this study, 2,562 women, 1,357 (53%) MNP and 1,205 (47%) non-MNP, were analyzed. Blood pressure, heart rate, body mass index, waist circumference, and depression/anxiety screening using the Hospital Depression/Anxiety Scale (HADS) were measured. We collected a blood sample in fasting state for glycemia, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides. Logistic regression models were fitted with a backward method from the potentially confusing variables of the menopause study groups.

RESULTS

Age 49.4 (±15.9) years; 10.1% belonged to semi-rural population; 87.5% had children. Regarding the educational level, 22.1% had <5 years of education, 31.3% had between 6 and 7 years, 33.4% had between 8 and 12 years, and 13.2% had >12 years of education. The prevalence of CMRF was significantly higher in MNP women, except for smoking. We did not find any differences in the prevalence of depression or anxiety between MNP and non-MNP women. Health was perceived as worse among MNP women (P<0.05) and patients over 45 years of age than patients younger than 45 years. We found a relationship between the negative health perception with metabolic syndrome, depression, and anxiety, having children, smoking, residing in rural area, and low educational level; nevertheless, it is not correlative with MNP status.

CONCLUSION

Perceived health should be viewed as a multifaceted condition related to social circumstances, and various symptoms in women, including menopause symptoms, but not with MNP state itself.

What to say and how to say it: effective communication for cardiovascular disease prevention

PURPOSE OF REVIEW

Current guidelines for cholesterol treatment emphasize the importance of engaging patients in a risk-benefit discussion prior to initiating statin therapy.

RECENT FINDINGS

Although current risk prediction algorithms are well defined, there is less data on how to communicate with patients about cardiovascular disease risk, benefits of treatment, and possible adverse effects.

SUMMARY

We propose a four-part model for effective shared decision-making: 1) Assessing patient priorities, perceived risk, and prior experience with cardiovascular risk reduction; 2) Arriving at a recommendation for therapy based on the patient's risk of disease, guideline recommendations, new clinical trial data, and patient preferences; 3) Communicating this recommendation along with risks, benefits, and alternatives to therapy following best practices for discussing numeric risk; and 4) Arriving at a shared decision with the patient with ongoing reassessment as risk factors and patient priorities change.

Disentangling the effect of illness perceptions on health status in people with type 2 diabetes after an acute coronary event

BACKGROUND

Chronically ill patients such as people with type 2 diabetes develop perceptions of their illness, which will influence their coping behaviour. Perceptions are formed once a health threat has been recognised. Many people with type 2 diabetes suffer from multimorbidity, for example the combination with cardiovascular disease. Perceptions of one illness may influence perceptions of the other condition. The aim of the current study was to evaluate the effect of an intervention in type 2 diabetes patients with a first acute coronary event on change in illness perceptions and whether this mediates the intervention effect on health status. The current study is a secondary data analysis of a RCT.

METHODS

Two hundred one participants were randomised (1:1 ratio) to the intervention (n = 101, three home visits) or control group (n = 100). Outcome variables were diabetes and acute coronary event perceptions, assessed with the two separate Brief Illness Perceptions Questionnaires (BIPQs); and health status (Euroqol Visual Analog Scale (EQ-VAS)). The intervention effect was analysed using ANCOVA. Linear regression analyses were used to assess whether illness perceptions mediated the intervention effect on health status.

RESULTS

A positive intervention effect was found on the BIPQ diabetes items coherence and treatment control (F = 8.19, p = 0.005; F = 14.01, p < 0.001). No intervention effect was found on the other BIPQ diabetes items consequence, personal control, identity, illness concern and emotional representation. Regarding the acute coronary event, a positive intervention effect on treatment control was found (F = 7.81, p = 0.006). No intervention effect was found on the other items of the acute coronary event BIPQ. Better diabetes coherence was associated with improved health status, whereas perceiving more treatment control was not. The mediating effect of the diabetes perception 'coherence' on health status was not significant.

CONCLUSION

Targeting illness perceptions of people with diabetes after an acute coronary event has no effect on most domains, but can improve the perceived understanding of their diabetes. Discussing perceptions prevents people with type 2 diabetes who recently experienced an acute coronary event from the perception that they will lose control of both their diabetes and the acute coronary event. Illness perceptions of diabetes patients should therefore be discussed in the dynamic period after an acute coronary event.

TRIAL REGISTRATION

Nederlands trial register; NTR3076 , Registered September 20 2011.

Are Perceived Prevalences of Infection also Biased and How? Lessons from Large Epidemics of Mosquito-Borne Diseases in Tropical Regions

BACKGROUND

Although people are likely to underestimate the frequencies of risks to health from common diseases and overestimate those from rare diseases, we still do not know much about reasons for this systematic bias, which is also referred to as "primary bias" in the literature. In this study, we take advantage of a series of large epidemics of mosquito-borne diseases to examine the accuracy of judgments of risk frequencies. In this aim, we assessed the perceived v. observed prevalence of infection by Zika, chikungunya or dengue fever during these outbreaks, as well as their variations among different subpopulations and epidemiological settings.

METHODS

We used data drawn from 4 telephone surveys, conducted between 2006 and 2016, among representative samples of the adult population in tropical regions (Reunion, Martinique, and French Guiana). The participants were asked to estimate the prevalence of these infections by using a natural frequency scale.

RESULTS

The surveys showed that 1) most people greatly overestimated the prevalence of infection by arbovirus, 2) these risk overestimations fell considerably as the actual prevalence of these diseases increased, 3) the better-educated and male participants consistently yielded less inaccurate risk estimates across epidemics, and 4) these biases in the perception of prevalence of these infectious diseases are relatively well predicted by the probability weighting function developed in the field of behavioral decision making.

CONCLUSIONS

These findings suggest that the primary bias, which has been found in laboratory experiments to characterize a variety of probabilistic judgments, equally affects perception of prevalence of acute infectious diseases in epidemic settings. They also indicate that numeracy may play a considerable role in people's ability to transform epidemiological observations from their social environment to more accurate risk estimates.

Effect of a health literacy intervention trial on knowledge about cardiovascular disease medications among Indigenous peoples in Australia, Canada and New Zealand

OBJECTIVES

To assess the effect of a customised, structured cardiovascular disease (CVD) medication health literacy programme on medication knowledge among Indigenous people with, or at high risk of, CVD.

DESIGN

Intervention trial with premeasures and postmeasures at multiple time points.

SETTING

Indigenous primary care services in Australia, Canada and New Zealand.

PARTICIPANTS

171 Indigenous people aged ≥20 years of age who had at least one clinical diagnosis of a CVD event, or in Canada and Australia had a 5-year CVD risk ≥15%, and were prescribed at least two of the following CVD medication classes: statin, aspirin, ACE inhibitors and beta blockers.

INTERVENTION

An education session delivered on three occasions over 1 month by registered nurses or health educators who had received training in health literacy and principles of adult education. An interactive tablet application was used during each session and an information booklet and pill card provided to participants.

PRIMARY OUTCOME MEASURES

Knowledge about the CVD medications assessed before and after each session.

RESULTS

Knowledge at baseline (presession 1) was low, with the mean per cent correct answers highest for statins (34.0% correct answers), 29.4% for aspirin, 26.0% for beta blockers and 22.7% for ACE inhibitors. Adjusted analyses showed highly significant (P<0.001) increases in knowledge scores between preassessments and postassessments at all three time points for all medication classes. For the four medications, the absolute increases in adjusted per cent correct items from presession 1 to postsession 3 assessments were 60.1% for statins, 76.8% for aspirin, 71.4% for ACE inhibitor and 69.5% for beta blocker.

CONCLUSIONS

The intervention was highly effective in contextually diverse Indigenous primary healthcare services in Australia, Canada and New Zealand. The findings from this study have important implications for health services working with populations with low health literacy more generally.

TRIAL REGISTRATION NUMBER

ACTRN12612001309875.

Association between clinical factors and self-underestimation of cardiovascular risk in subjects submitted to a routine health evaluation

BACKGROUND

The perception of cardiovascular (CV) risk is essential for adoption of healthy behaviors. However, subjects underestimate their own risk.

HYPOTHESIS

Clinical characteristics might be associated with self-underestimation of CV risk.

METHODS

This is a retrospective, cross-sectional study of individuals submitted to routine health evaluation between 2006 and 2012, with calculated lifetime risk score (LRS) indicating intermediate or high risk for CV disease (CVD). Self-perception of risk was compared with LRS. Logistic regression analysis was performed to test the association between clinical characteristics and subjective underestimation of CV risk.

RESULTS

Data from 5863 subjects (age 49.4 ± 7.1 years; 19.9% female) were collected for analysis. The LRS indicated an intermediate risk for CVD in 45.7% and a high risk in 54.3% of individuals. The self-perception of CV risk was underestimated compared with the LRS in 4918 (83.9%) subjects. In the adjusted logistic regression model, age (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.10-1.47 per 10 years, P = 0.001), smoking (OR: 1.99, 95% CI: 1.40-2.83, P < 0.001), dyslipidemia (OR: 1.21, 95% CI: 1.01-1.46, P = 0.045), physical activity (OR: 1.66, 95% CI: 1.36-2.02, P < 0.001), and use of antihypertensive (OR: 1.49, 95% CI: 1.15-1.92, P = 0.002) and lipid-lowering medications (OR: 2.13, 95% CI: 1.56-2.91, P < 0.001) were associated with higher chance of risk underestimation, whereas higher body mass index (OR: 0.92, 95% CI: 0.90-0.94, P < 0.001), depressive symptoms (OR: 0.46, 95% CI: 0.37-0.57, P < 0.001), and stress (OR: 0.41, 95% CI: 0.33-0.50, P < 0.001) decreased the chance.

CONCLUSIONS

Among individuals submitted to routine medical evaluation, aging, smoking, dyslipidemia, physical activity, and use of antihypertensive and lipid-lowering medications were associated with higher chance of CV risk underestimation. Subjects with these characteristics may benefit from a more careful risk orientation.

Perceptions of risk of coronary heart disease among people living with type 2 diabetes mellitus

AIMS

Our aim is to assess perception of risk of developing coronary heart disease and to examine its associations with individuals' characteristics and health behaviours among Omani people with type 2 diabetes mellitus (T2DM).

BACKGROUND

Evaluating perceptions of being at risk of developing a disease may give insight into health promotion behaviours. People with diabetes are at high risk of coronary heart disease. The management of diabetes mellitus should include prevention and control of coronary heart disease.

DESIGN

A cross-sectional correlational study was conducted.

METHODS

A convenience sample of 160 adults with T2DM was invited to participate in this study between November 2014 and March 2015. Descriptive and regression analyses were performed to examine associations between study variables.

RESULTS

Perception of risk of developing coronary heart disease was significantly associated with low educational level (β = 0.191, P < .05), low income (β = 0.201, P < .05), and high level of knowledge about diabetes mellitus (β = 0.200, P < .05). People with T2DM who perceived coronary heart disease as having few moderate known outcomes and consequences reported consuming healthy diet more frequently.

CONCLUSION

Teaching people with T2DM about the risk of developing coronary heart disease is essential as it could motivate them to perform health promotion behaviours, which may assist in controlling and reducing coronary heart disease.

Knowledge and perception of cardiovascular disease risk among patients with rheumatoid arthritis

Patients with rheumatoid arthritis are at increased risk for cardiovascular disease. The prerequisites for reducing the risk of cardiovascular disease are adequate levels of knowledge and being aware of the risk. In this study, the levels of knowledge about cardiovascular disease among patients with rheumatoid arthritis and the perception were evaluated in relation to their actual 10-year risk of cardiovascular disease. This cross-sectional study of 200 patients with rheumatoid arthritis was conducted in a university-affiliated hospital in South Korea. The patients' actual risk of cardiovascular disease was estimated using the Framingham Risk Score. The most common risk factor was physical inactivity, with 77% of the patients not engaging in regular exercise. The patients lacked knowledge about the effects of physical inactivity and anti-inflammatory medication on the development of cardiovascular disease. Misperceptions about the risk of cardiovascular disease were common, i.e., 19.5% of the patients underestimated their risk and 41% overestimated. Hypertension, diabetes, obesity, and smoking were the most prevalent among the patients who underestimated their risk, and these same patients had the lowest level of knowledge about cardiovascular disease. This study demonstrated the rheumatoid arthritis patients' lack of knowledge about the effects of physical inactivity and anti-inflammatory medications on the development of cardiovascular disease, and their misperception of cardiovascular risk was common. As a preventive measure, educational programs about cardiovascular disease should be tailored specifically for patients with rheumatoid arthritis, and behavioral interventions, including routine exercise, should be made available at the time of diagnosis.

Perceptions of risks for diabetes-related complications in Type 2 diabetes populations: a systematic review

AIM

In Type 2 diabetes, there is no clear understanding of how people perceive their risk of experiencing diabetes-related complications. To address this issue, we undertook an evidence-based synthesis of how people with Type 2 diabetes perceive their risk of complications.

METHODS

We performed a systematic search of nine electronic databases for peer-reviewed articles published on or before 1 March 2016. Data from 18 studies reporting lay perceptions of risks for complications in Type 2 diabetes populations were included. Publication year ranged between 2002 and 2014.

RESULTS

Methods used to assess risk perceptions were heterogeneous, ranging from questionnaires measuring the accuracy of perceived risks to semi-structured and focus group interviews. We found evidence of low risk awareness in most dimensions of risk perceptions measured and the existence of optimistic bias.

CONCLUSIONS

Perceptions were generally biased and varied according to the dimension of risk measured, the subpopulation concerned and the type of complications considered. Future work is needed to identify the best practical ways of correcting for biased risk perceptions so as to encourage self-care behaviours and treatment adherence.

Risk communication in the dental practice

The communication of risk in dental settings is a routine task that most clinicians are familiar with in their clinical encounters. However, work from medical settings has suggested that using this process in order to support health behaviour change in people may well be undermined by difficulties in understanding risk information, in presenting the information in a way that is clearly understood by the recipient and in the effects that such information may have for supporting further health behaviours by patients. This paper synthesises literature in the area that addresses these issues and explores approaches dental care professionals might consider when communicating risks in the dental surgery.

Comparison of self-perceived cardiovascular disease risk among smokers with Framingham and PROCAM scores: a cross-sectional analysis of baseline data from a randomised controlled trial

OBJECTIVES

Previous studies suggest that smokers have a misperception of their 10-year cardiovascular risk. We aimed to compare 10-year cardiovascular risk self-perception and calculated risk among smokers willing to quit and assess the determinants of a possible misperception.

DESIGN

Cross-sectional secondary analysis of baseline data from a randomised controlled trial of smoking cessation.

PARTICIPANTS

514 participants, mean age 51.1 years, 46% women, 98% Caucasian. Eligible participants were regular smokers, aged between 40 and 70 years, with a consumption of at least 10 cigarettes per day for at least a year. None of them had experienced cardiovascular disease before. Exclusion criteria comprised a history of myocardial infarction, coronary heart disease, stroke, heart failure, peripheral vascular disease, carotid atherosclerosis or cardiac arrhythmia. Participants with renal or liver failure, psychiatric disorders, substance and alcohol abuse and with smoking cessation therapies were excluded.

INTERVENTIONS

Participants were asked to estimate their 10-year cardiovascular risk using a 3-item scale corresponding to high-risk, moderate-risk and low-risk categories. We compared their risk perception with Framingham and Prospective Cardiovascular Munster Study (PROCAM) scores. We used multivariable-adjusted logistic regression models to determine characteristics of participants who underestimate their risk versus those who correctly estimate or overestimate it.

RESULTS

Between 38% and 42% of smokers correctly perceived their 10-year cardiovascular risk, and 39-50% overestimated their 10-year cardiovascular risk while 12-19% underestimated it compared with their calculated 10-year cardiovascular risk depending on the score used. Underestimation of 10-year cardiovascular risk was associated with male gender (OR 8.16; CI 3.83 to 17.36), older age (OR 1.06; CI 1.02 to 1.09), and the presence of hyperlipidaemia (OR 2.71; CI 1.47 to 5.01) and diabetes mellitus (OR 13.93; CI 3.83 to 50.66).

CONCLUSIONS

Among smokers, misperception of their 10-year cardiovascular risk is common, with one-fifth underestimating it. These findings may help physicians target patients with such characteristics to help them change their health behaviour and adherence to risk-reduction therapy.

TRIAL REGISTRATION NUMBER

NCT00548665; Post-results.

Inaccurate risk perceptions contribute to treatment gaps in secondary prevention of cardiovascular disease

BACKGROUND

All patients with cardiovascular disease (CVD) are at high risk of recurrent events. Despite strong evidence, large treatment gaps exist in CVD secondary prevention. We hypothesise that patients' self-perception and general practitioner's (GP) assessment of future cardiovascular (CV) risk may influence secondary prevention behaviours.

AIM

To examine in patients with known CVD the perceived risk of future CV events and its relationship with use of secondary prevention medications and risk factor control.

METHODS

We examined patient and practitioner's perceived risk and its relationship with the uptake of secondary prevention recommendations in adults with CVD participating in the Australian Hypertension and Absolute Risk Study.

RESULTS

Among the 1453 participants, only 11% reported having a high absolute risk and 29% reported high relative risk of recurrent events. The GP categorised only 30% as having a 5-year risk ≥15%. After adjusting for covariates, hospitalisation within the preceding 12 months was the only significant predictor of patients' accurate risk perception. Conventional CV risk factors were predictive of the GP's risk estimates. Patients who accurately understood their risk reported higher smoking cessation rates (7 vs 3%, P = 0.003) and greater use of antiplatelet, blood pressure lowering therapy and statins (P ≤ 0.01). However, there was no relationship between GP's risk perception and secondary prevention treatments.

CONCLUSION

Both patients and GP have optimistic bias and underestimate the risk of future CV events. Patients' accurate self-perception, but not GP risk perception, was associated with improved secondary preventative behaviours. This suggests that helping patients to understand their risk may influence their motivation towards secondary prevention. Providing support to GP or programmes to help patients better understand their risks could have potential benefit on secondary prevention behaviours.

Health Risk Perceptions and Exercise in Older Adulthood

Protection Motivation Theory (PMT) was applied to explore the relationship between perceived risk of acute health crises and intent to exercise. Interviews of 351 community-living older adults assessed prior physical activity (PPA), all PMT components, and exercise intent. A multi-group structural equation model revealed gender differences in PMT predictors of exercise intent. PPA, age, self-efficacy, and response efficacy directly predicted men’s intent. Women’s PPA and age predicted PMT components of self-efficacy and response costs, which predicted intent. Findings have implications for devising interventions to enhance physical activity in later life by targeting different PMT components for older men and women.

[Reliability and external validity of a questionnaire to assess the knowledge about risk and cardiovascular disease and in patients attending Spanish community pharmacies]

Objetivos

Determinar la fiabilidad test-retest de un cuestionario, con validación preliminar, para valorar el conocimiento sobre riesgo cardiovascular (RCV) y enfermedad cardiovascular, en pacientes atendidos en farmacias comunitarias de España. Complementar la validez externa, estableciendo la relación entre una actividad educativa y el aumento del conocimiento sobre RCV y enfermedad cardiovascular.

Diseño

Subanálisis del estudio clínico controlado EMDADER-CV, en el que se aplicó un cuestionario de conocimiento sobre RCV en 4 momentos.

Emplazamiento

Farmacia comunitaria española.

Participantes

Trescientos veintitrés pacientes del grupo control, de los 640 que finalizaron el estudio.

Mediciones principales

Coeficiente de correlación intraclase para evaluar la fiabilidad en 3 comparaciones (postactividad educativa con semana 16, postactividad educativa con semana 32, y semana 16 con semana 32); y prueba no paramétrica de Friedman para establecer la relación entre una actividad educativa oral y escrita con el aumento del conocimiento.

Resultados

Para los 323 pacientes, en las 3 comparaciones, los valores del coeficiente de correlación intraclase fueron 0,624; 0,608 y 0,801 (fiabilidad aceptable-buena a excelente). Por su parte, la prueba de Friedman mostró relación entre la actividad educativa y el aumento del conocimiento, estadísticamente significativa (p < 0,0001).

Conclusiones

Acorde con el coeficiente de correlación intraclase, el cuestionario orientado a valorar el conocimiento sobre el RCV y enfermedad cardiovascular tiene una fiabilidad entre aceptable y excelente, lo cual, sumado a la validación previa, indica que dicho instrumento cumple los criterios de validez y fiabilidad. Además, el cuestionario evidencia capacidad de relacionar un aumento en el conocimiento con una intervención educativa, característica que complementa su validez externa.

Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system

Background

Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands.

Methods

We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors.

Results

Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients’ lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals’ and patients’ views on patient’s knowledge and self-management.

Conclusions

Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients’ knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.

Prognostic Value of Stress Echocardiography in Patients With Low-Intermediate or High Short-Term (10 Years) Versus Low (<39%) or High (≥39%) Lifetime Predicted Risk of Cardiovascular Disease According to the American College of Cardiology/American Heart Association 2013 Cardiovascular Risk Calculator

This study evaluates the prognostic value of stress echocardiography (Secho) in short-term (10 years) and lifetime atherosclerotic cardiovascular disease risk-defined groups according to the American College of Cardiology/American Heart Association 2013 cardiovascular risk calculator. The ideal risk assessment and management of patients with low-to-intermediate or high short-term versus low (<39%) or high (≥39%) lifetime CV risk is unclear. The purpose of this study was to evaluate the prognostic value of Secho in short-term and lifetime CV risk-defined groups. We evaluated 4,566 patients (60 ± 13 years; 46% men) who underwent Secho (41% treadmill and 59% dobutamine) with low-intermediate short-term (<20%) risk divided into low (<39%, n = 368) or high (≥39%, n = 661) lifetime CV risk and third group with high short-term risk (≥20%, n = 3,537). Follow-up (3.2 ± 1.5 years) for nonfatal myocardial infarction (n = 102) and cardiac death (n = 140) were obtained. By univariate analysis, age (p <0.001) and ≥3 new ischemic wall motion abnormalities (WMAs, p <0.001) were significant predictors of cardiac events. Cumulative survival in patients was significantly worse in patients with ≥3 WMA versus <3 WMA in low-intermediate short-term and low (3.3% vs 0.3% per year, p <0.001) or high (2.0% vs 0% per year, p <0.001) lifetime risk and also in those with high short-term CV risk group (3.5% vs 1.0% per year, p <0.001). Multivariate Cox proportional hazards analysis identified ≥3 new ischemic WMAs as the strongest predictor of cardiac events (hazard ratio 3.0, 95% confidence interval 2.3 to 3.9, p <0.001). In conclusion, Secho results (absence or presence of ≥3 new ischemic segments) can further refine risk assessment in patients with low-intermediate or high short-term versus low or high lifetime cardiovascular risk. Event rate with normal Secho is low (≤1% per year) but higher in patients with high short-term CV risk by the American College of Cardiology/American Heart Association 2013 cardiovascular risk calculator.

Self-perceived health versus actual cardiovascular disease risks

AIM

Self-perceived poor health is related to cardiovascular disease (CVD) risk perception, cardiovascular event, hospital readmission, and death from CVD. This study evaluated the associations between self-perceived health and actual CVD risk in South Koreans as well as the influence of sociodemographic and cardiovascular risk factors on self-perceived poor health.

METHODS

This is a secondary data analysis of the 2010 Korea National Health and Nutrition Examination Survey. The sample was 4535 South Koreans aged 30-74 years without CVD. Self-perceived health status was compared with actual cardiovascular risk separately by sex using χ(2) -tests. Logistic regressions were used to identify potential sociodemographic and cardiovascular risk factors of self-perceived poor health.

RESULTS

Self-perceived poor health was related to higher CVD risk but there were substantial gaps between them. Among cardiovascular risk factors, dyslipidemia, obesity, smoking, and a family history of CVD did not affect self-perceived health.

CONCLUSION

Gaps between perceived health and actual CVD risk should be closed to optimize cardiovascular health of South Koreans. Koreans need to increase risk perception to a level commensurate with their actual risk. Healthcare providers should try to provide individuals at increased CVD risk with better information more frequently, especially those who have favorable perceptions of their health but smoke or have elevated cholesterol levels and bodyweight.

Cardiovascular disease medication health literacy among Indigenous peoples: design and protocol of an intervention trial in Indigenous primary care services

Background

Cardiovascular diseases (CVD) are leading causes of mortality and morbidity among Indigenous people in New Zealand, Australia and Canada and are a major driver of the inequities in life expectancy between Indigenous and non-Indigenous people in these countries. Evidence-based pharmaceutical management of CVD can significantly reduce mortality and morbidity for persons diagnosed with CVD or for those at intermediate or high risk of CVD. Health literacy has been identified as a major barrier in the communication and implementation of appropriate pharmaceutical management plans for CVD. Addressing health literacy is particularly relevant in Indigenous populations where there are unique health and adult literacy challenges.

Methods/design

This study will examine the effect of a customized, structured CVD medication programme, delivered by health professionals, on the health literacy of Indigenous people with, or at risk, of CVD. Primary outcomes are patient’s knowledge about CVD medications; secondary outcomes examine changes in health literacy skills and practices. The study will employ a multi-site pre-post design with multiple measurement points to assess intervention efficacy. Participants will be recruited from four Indigenous primary care services in Australia, Canada and New Zealand. Three educational sessions will be delivered over four weeks. A tablet application will support the education sessions and produce a customized pill card for each participant. Participants will be provided with written information about CVD medications. Medication knowledge scores, and specific health literacy skills and practices will be assessed before and after the three sessions. Statistical analyses will identify significant changes in outcomes over each session, and from the pre-session one to post-session three time points.

Discussion

This study will make an important contribution to understanding the effect of a structured primary care-based intervention on CVD health literacy in Indigenous populations. The study also illustrates the incorporation of Indigenous health research principles and processes in clinical trials and provides insights that may be useful in other contexts.

Trial registration

Australian and New Zealand Clinical Trials Register (ACTRN12612001309875; date of registration 18/12/2012).

Predictors of health-promoting behavior associated with cardiovascular diseases among Korean blue-collar workers

The aim of this study was to investigate the contribution of actual cardiovascular disease (CVD) risks, psychosocial and work-related factors as predictors of health behavior. A sample of 234 Korean blue-collar workers, who worked in small companies, was included in this cross-sectional study. Data collection included a survey; anthropometric and blood pressure measures; and blood sampling. Multiple regression analyses showed that the model explained 30% of the variance in health behavior of blue-collar workers. The significant predictors for health behavior included education level, perceived general health, greater family function, higher social support, decision latitude, and non-shift work. Future research should focus on incorporating these significant predictors into effective behavioral interventions designed to promote cardiovascular health in this population.

Actual cardiovascular disease risk and related factors: a cross-sectional study of Korean blue collar workers employed by small businesses

Actual cardiovascular disease (CVD) risk and related factors among blue collar workers employed by small businesses were investigated. This cross-sectional study of 238 Korean blue collar workers used surveys, anthropometric and blood pressure measurements, and blood sampling for lipid and glucose levels to answer the research questions. Multiple regression techniques were used to analyze study data. The prevalence of actual CVD risk among blue collar workers was 32 cases per 100 workers. A multiple regression model showed that a combination of individual, psychosocial, and work-related factors explained 34% of the variance in actual CVD risk. The significant predictors of actual CVD risk included knowledge of CVD risk, risk perception, job stress, and waist-to-hip ratio. It is important for clinicians to consider all of these significant predictors of actual CVD risk when designing an intervention program to reduce CVD among Korean blue collar workers.

Starting and staying on preventive medication for cardiovascular disease

PURPOSE OF REVIEW

To synthesize the qualitative research literature regarding medication use to prevent cardiovascular disease in order to explain the variation in healthcare professional (HCP) and patient behaviours, and to evaluate the implications for practice.

RECENT FINDINGS

The decision to start preventive medication is affected by the patient-HCP relationship and by the design of the service. Both HCPs and patients are influenced by their understanding of the evidence regarding the value of preventive interventions; their values and preferences; and their sociopolitical context and the organizational structure of their practice environment. The design of their service affects uptake as a consequence of its impact on clinical communication and the extent to which the service is tailored to the needs of the local community. Continuing to take prescribed medication is affected by both contextual and practical factors. Recommendations for practice can be split into those with a clinical focus and those with a patient or community focus. More sophisticated analyses have moved beyond recommendations for patient and HCP education, and address constraints in the organization of clinical services and the social context of evidence translation.

SUMMARY

Qualitative health research provides important insights into the experience of and context for decision making about medication prescription and adherence that can help efforts to prevent cardiovascular disease.

Development of a Comprehensive Heart Disease Knowledge Questionnaire

BACKGROUND: Heart disease is the number one killer of both men and women in the United States, yet a comprehensive and evidence-based heart disease knowledge assessment is currently not available. PURPOSE: This paper describes the 2 phase development of a novel heart disease knowledge questionnaire. METHODS: After review and critique of the existing literature, a questionnaire addressing 5 central domains of heart disease knowledge was constructed. In Phase I, 606 undergraduates completed a 82-item questionnaire. In Phase II, 248 undergraduates completed a revised 74-item questionnaire. In both phases, item clarity and difficulty were evaluated, along with the overall factor structure of the scale. RESULTS: Exploratory and confirmatory factor analyses were used to reduce the scale to 30 items with fit statistics, CFI = .82, TLI = .88, and RMSEA = .03. Scores were correlated moderately positively with an existing scale and weakly positively with a measure of health literacy, thereby establishing both convergent and divergent validity. DISCUSSION: The finalized 30-item questionnaire is a concise, yet discriminating instrument that reliably measures participants' heart disease knowledge levels. TRANSLATION TO HEALTH EDUCATION PRACTICE: Health professionals can use this scale to assess their patients' heart disease knowledge so that they can create a tailored program to help their patients reduce their heart disease risk.

Cardiovascular risk

Cardiovascular disease is a major, growing, worldwide problem. It is important that individuals at risk of developing cardiovascular disease can be effectively identified and appropriately stratified according to risk. This review examines what we understand by the term risk, traditional and novel risk factors, clinical scoring systems, and the use of risk for informing prescribing decisions. Many different cardiovascular risk factors have been identified. Established, traditional factors such as ageing are powerful predictors of adverse outcome, and in the case of hypertension and dyslipidaemia are the major targets for therapeutic intervention. Numerous novel biomarkers have also been described, such as inflammatory and genetic markers. These have yet to be shown to be of value in improving risk prediction, but may represent potential therapeutic targets and facilitate more targeted use of existing therapies. Risk factors have been incorporated into several cardiovascular disease prediction algorithms, such as the Framingham equation, SCORE and QRISK. These have relatively poor predictive power, and uncertainties remain with regards to aspects such as choice of equation, different risk thresholds and the roles of relative risk, lifetime risk and reversible factors in identifying and treating at-risk individuals. Nonetheless, such scores provide objective and transparent means of quantifying risk and their integration into therapeutic guidelines enables equitable and cost-effective distribution of health service resources and improves the consistency and quality of clinical decision making.

Aspirin use and cardiovascular events in social networks

We tested whether friends' and family members' cardiovascular health events and also their own aspirin use are associated with the likelihood that an individual takes aspirin regularly. Analyses were based on longitudinal data on 2724 members of the Framingham Heart Study (based in Massachusetts, U.S.A.) who were linked to friends and family members who were also participants in the same study. Men were more likely to take aspirin if a male friend had recently been taking aspirin, and women were more likely to take aspirin if a brother had recently been taking aspirin. Men were also more likely to take aspirin if a brother recently had a cardiovascular event, and women were more likely to take aspirin if a female friend recently experienced a cardiovascular event. Aspirin use is correlated with the health and behavior of friends and family. These findings add to a growing body of evidence which suggests that behavioral changes that promote cardiovascular health may spread through social networks.

SRH and HrQOL: does social position impact differently on their link with health status?

Background

Self-rated Health (SRH) and health-related quality of life (HRQoL) are used to evaluate health disparities. Like all subjective measures of health, they are dependent on health expectations that are associated with socioeconomic characteristics. It is thus needed to analyse the influence played by socioeconomic position (SEP) on the relationship between these two indicators and health conditions if we aim to use them to study health disparities. Our objective is to assess the influence of SEP on the relationship between physical health status and subjective health status, measured by SRH and HRQoL using the SF-36 scale.

Methods

We used data from the French National Health Survey. SEP was assessed by years of education and household annual income. Physical health status was measured by functional limitations and chronic low back pain.

Results

Regardless of their health status, people with lower SEP were more likely than their more socially advantaged counterparts to report poor SRH and poorer HRQoL, using any of the indicators of SEP. The negative impact of chronic low back pain on SRH was relatively greater in people with a high SEP than in those with a low SEP. In contrast, chronic low back pain and functional limitations had less impact on physical and mental component scores of quality of life for socially advantaged men and women.

Conclusions

Both SRH and HRQoL were lower among those reporting functional limitations or chronic low back pain. However, the change varied according SEP and the measure. In relative term, the negative impact of a given health condition seems to be greater on SRH and lower on HRQoL for people with higher SEP in comparison with people with low SEP. Using SRH could thus decrease socioeconomic differences. In contrast using HRQoL could increase these differences, suggesting being cautious when using these indicators for analyzing health disparities.