Cardiovascular risk perception in women: true unawareness or risk miscalculation?

Gender and Social Inequalities in Awareness of Coronary Artery Disease in European Countries

Coronary artery disease (CAD) is the single leading cause of death in Europe and the most common form of cardiovascular disease. Little is known about awareness in the European population. A cross-sectional telephone survey of 2609 individuals from six European countries was conducted to gather information on perceptions of CAD, risk factors, preventive measures, knowledge of heart attack symptoms and ability to seek emergency medical care. Level of awareness was compared according to gender, age, socioeconomic status (SES) and educational level. Women were approximately five times less likely than men to consider heart disease as a main health issue or leading cause of death (OR = 0.224, 95% CI: 0.178–0.280, OR = 0.196, 95% CI: 0.171–0.226). Additionally, women were significantly less likely to have ever had a cardiovascular screening test (OR = 0.515, 95% CI: 0.459–0.578). Only 16.3% of men and 15.3% of women were able to spontaneously identify the main symptoms of a heart attack. Almost half of the sample failed to state that they would call emergency services in case of a cardiac event. Significant differences according to age, SES and education were found for many indicators amongst both men and women. Development of a European strategy targeting improved awareness of CAD and reduced gender and social inequalities within the European population is warranted.

Developing and validating a questionnaire to assess an individual's perceived risk of four major non-communicable diseases in Myanmar

Adopting healthy lifestyles is greatly influenced by an individual's perceived risk of developing non-communicable diseases (NCDs). This study aimed to develop and validate a questionnaire that can assess an individual's perceived risk of developing four major NCDs. We used the exploratory sequential mixed methods design. The qualitative part developed a questionnaire by two rounds of Delphi expert panels. The quantitative part validated the questionnaire using both exploratory (EFA) and confirmatory factor analysis (CFA). We used separate samples for EFA (n = 150) and CFA (n = 210). The participants were aged between 25-60 years of both sexes with no known history of NCDs, and face-to-face interviews were conducted. First, we generated an 86-item questionnaire based on the health belief model. Two expert panels ensured the questionnaire's content validity. The experts removed the overlapped items and items that did not represent the specific construct and developed a 51-item questionnaire. Next, we validated the questionnaire. We conducted a parallel analysis to determine the number of factors to be extracted. EFA constituted a five-factor model with 22 high loading items, which extracted 54% of the variance. We run four CFA models (single factor, five-factor, bifactor, and hierarchical) and tested the hypothesized five-factor model. It was found that the 21-item questionnaire (removed one efficacy item due to low loading) was satisfied with good psychometric properties and fitted with observed data in the bifactor model (RMSEA = 0.051, CFI = 0.954, TLI = 0.938, SRMR = 0.054). Hence, an individual's perceived risk of getting NCDs was constituted with a general perceived risk construct and five specific constructs (perceived susceptibility, perceived barrier, perceived benefit, perceived self-efficacy, and perceived behavioral change intention). It can be measured using the developed questionnaire (NCD-PR5-21). Further research is warranted to assess the questionnaire's utility in a mismatch between risk perception and current risk; and individualized counseling for behavioral change communication.

Standardized Postpartum Follow-Up for Women with Pregnancy Complications: Barriers to Access and Perceptions of Maternal Cardiovascular Risk

OBJECTIVE

Certain obstetrical complications are known to increase a woman's risk of future cardiovascular disease (CVD). The Maternal Health Clinic (MHC) provides postpartum cardiovascular risk counselling and follow-up; however, half of women referred do not attend. This study aimed to identify barriers to access, as well as whether attendance at the MHC improved the accuracy of patients' CVD risk perception.

METHODS

MHC patients completed a CVD risk perception questionnaire prior to being assessed and 3 months after their appointment ("attendees"). Calculated lifetime CVD risk scores were compared with perceived risk to assess accuracy of risk perception. Patients who did not attend their MHC appointment ("non-attendees") were administered the questionnaire by phone and asked about perceived barriers to access.

RESULTS

Sixty-seven of 137 eligible attendees (48.9%) completed both the pre- and post-MHC questionnaires. Significantly more participants accurately estimated their absolute CVD risk after their MHC appointment, although the majority continued to underestimate their risk. Among non-attendees, 81 of 130 women (62.3%) completed the questionnaire. The most common barriers to access cited were being too busy with childcare, accessing follow-up with the patient's family doctor instead, and difficulty attending their appointment.

CONCLUSION

Lack of time and inconvenience were two common barriers to accessing the MHC. Improved collaboration with primary care providers and use of telemedicine may help to mitigate these issues. Both attendees and non-attendees appeared to have an inadequate perception of CVD risk. Standardized postpartum CVD risk screening and counselling may be an effective method of providing these women with risk education and improving the accuracy of their risk perception.

Does Gender Influence the Relationship Between High Blood Pressure and Dementia? Highlighting Areas for Further Investigation

BACKGROUND

Gender differences have been noted in studies linking blood pressure to all-cause dementia, and the two most common forms of dementia: Alzheimer's disease (AD) and vascular dementia (VaD). However, how gender modifies the relationship between blood pressure and dementia remains unclear.

OBJECTIVE

To review evidence for a gender modifying effect on the link between blood pressure and all-cause dementia.

METHODS

A systematic review was conducted according to PRISMA guidelines. Sixteen out of 256 reviewed articles met inclusion criteria.

RESULTS

For women, higher midlife systolic blood pressure (SBP) and hypertension were both associated with greater risk of all-cause dementia, AD, and VaD, in six out of seven studies. Two of these studies reported higher midlife SBP/hypertension were associated with greater risk for all-cause dementia in women, but not men. One study reported higher midlife SBP associated with greater AD risk in women, but not men. However, another study reported that midlife hypertension associated with AD risk in men, but not women. No clear gender differences were reported in the relationship between late-life high blood pressure/hypertension with all-cause dementia or AD.

CONCLUSION

Studies rarely, and inconsistently, analyzed or reported gender effects. Therefore, interpretation of available evidence regarding the role of gender in blood pressure associated dementia was difficult. Several studies indicated higher midlife SBP was associated with greater risk of all-cause dementia for women, compared to men. Future studies should evaluate women-specific aging processes that occur in midlife when considering the association between blood pressure and dementia risk.

Subjective Versus Objective Estimated Cardiovascular Disease Risk and Adherence to Physical Activity in African American Women

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death for African American (AA) women in the United States. Despite high prevalence of CVD risk factors, AA women perceive their CVD risk as low.

OBJECTIVE

Our objectives were to (1) identify relationships between subjective (self-reported perceived) CVD risk and objective CVD risk estimated by the American College of Cardiology/American Heart Association atherosclerotic CVD (ASCVD) risk estimator, (2) identify demographic and psychosocial factors associated with subjective perceived risk and discrepancy with objective estimated CVD risk, and (3) determine whether subjective perceived CVD risk was associated with physical activity (PA) adherence.

METHODS

This was a secondary data analysis of data collected from a 12-month lifestyle PA intervention conducted with 281 AA women. Subjective perceived CVD risk was measured by 1 question; objective estimated CVD risk was calculated using the ASCVD score. Women were categorized by congruence or discrepancy between subjective perceived and objective estimated CVD risk.

RESULTS

Subjective perceived CVD risk and objective ASCVD risk scores were both low. Approximately 20% subjectively perceived their risk as lower than objective ASCVD scores. Atherosclerotic CVD risk discrepancy groups differed by depressed mood symptoms. Participants reported many perceived barriers to PA. Perceived CVD risk was not related to PA adherence.

CONCLUSIONS

The significance of associated CVD risk factors may be underestimated by AA women, leading to discrepancy between subjective and objective risk estimates. Research is needed to clarify relationships among perceived risk, estimated risk using risk calculators such as ASCVD, and health behavior.

Outpatient Physical Therapist Attitudes Toward and Behaviors in Cardiovascular Disease Screening: A National Survey

BACKGROUND

Screening the cardiovascular system is an important and necessary component of the physical therapist examination to ensure patient safety, appropriate referral, and timely medical management of cardiovascular disease (CVD) and risk factors. The most basic screening includes a measurement of resting blood pressure (BP) and heart rate (HR). Previous work demonstrated that rates of BP and HR screening and perceptions toward screening by physical therapists are inadequate.

OBJECTIVE

The purpose was to assess the current attitudes and behaviors of physical therapists in the United States regarding the screening of patients for CVD or risk factors in outpatient orthopedic practice.

DESIGN

This was a cross-sectional, online survey study.

METHODS

Data were collected from an anonymous adaptive online survey delivered via an email list.

RESULTS

A total of 1812 surveys were included in this analysis. A majority of respondents (n = 931; 51.38%) reported that at least half of their current caseload included patients either with diagnosed CVD or at moderate or greater risk of a future occurrence. A total of 14.8% of respondents measured BP and HR on the initial examination for each new patient. The most commonly self-reported barriers to screening were lack of time (37.44%) and lack of perceived importance (35.62%). The most commonly self-reported facilitators of routine screening were perceived importance (79.48%) and clinic policy (38.43%). Clinicians who managed caseloads with the highest CVD risk were the most likely to screen.

LIMITATIONS

Although the sampling population included was large and representative of the profession, only members of the American Physical Therapy Association Orthopaedic Section were included in this survey.

CONCLUSIONS

Despite the high prevalence of patients either diagnosed with or at risk for CVD, few physical therapists consistently included BP and HR on the initial examination. The results of this survey suggest that efforts to improve understanding of the importance of screening and modifications of clinic policy could be effective strategies for improving rates of HR and BP screening.

Accuracy of self-perceived risk for common conditions

Background:

Accurate awareness of common disease risk is necessary to promote healthy lifestyles and to prevent unnecessary anxiety and evaluation. Our objective is to identify characteristics of patients who do not accurately perceive their risk of developing coronary heart disease (CHD), diabetes (DM), breast cancer (BC) and colorectal cancer (CRC).

Methods:

Using personalized disease risk reports and risk perception surveys, subjects (n = 4703) were classified as high or low/average risk and high or low/average perceived risk for each condition. Models were used to examine factors associated with risk under-estimation by high risk patients and risk over-estimation by low/average risk patients.

Results:

Patients at high risk for DM, BC and CRC often (60%−75% of the time) under-estimated their risk, while low/average risk patients overestimated their risk 13%−40% of the time. For CHD, under-estimation by high risk individuals approximated over-estimation by low/average individuals. Compared to normal weight patients at high risk for cancer, obese patients were more likely to under-estimate their risk for BC (OR 3.1, CI 1.9–5.0) and CRC (2.6, 1.5–4.5) as were overweight patients. Overweight and obese patients at low/average risk of DM or CHD were more likely than normal weight patients to over-estimate their risk. Low/average risk women were more likely than men to over-estimate their risk of DM (1.3, 1.1–1.5) and CHD (1.8, 1.5–2.1).

Conclusions:

Our data show that body mass index is the factor most consistently associated with incorrect risk perceptions for several common conditions.

Assessing Knowledge Regarding Managing Congestive Health Failure Symptoms: Differences in Patient and Professional Scores

Objective:

To assess whether patients with congestive heart failure (CHF) and health coaches agree about patient knowledge of health-enhancing practices related to CHF after ongoing telehealth coaching.

Methods:

Forty patients with CHF and eligible for both Medicare and Medicaid were recruited from a regional managed care organization for this pilot study. Telecoaching sessions via a health insurance portability and accountability act(HIPAA)-compliant tablet-based platform focused on educational information designed to improve patient self-care. Social workers administered the 13-item Member Confidence Measure at baseline and at 30 and 180 days into the intervention. Patients and social workers provided separate ratings.

Results:

As expected at baseline, patient and coach scores differed, with patients reporting higher perceived knowledge scores (P < .01). Contrary to expectation, patient and coach scores did not converge at 30 and 180 days. Patient scores continued to increase at 30 and 180 days, while coaches’ scores increased at 30 days, but not at 180 days.

Conclusion:

Overall, patients continued to overrate their understanding about CHF. A telecoaching platform provides an opportunity to enhance patient’s knowledge of their chronic disease and for patients to sustain that knowledge over time.

Practice Implications:

Addressing a patient’s misperception of their knowledge to manage a chronic disease is critical for enhancing well-being. Coaches’ scores did increase at 30 days suggesting that telecoaching is effective, but more monitoring may be required to ensure that these gains persist over time.