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November 9, 2018

The best way to talk about heart disease risk—if you want patients to take action

Daily Briefing

    How a doctor describes a patient's risk of heart disease could affect how seriously that patient takes those risks—and their willingness to take medication, according to a study published in JAMA Cardiology, Linda Carroll reports for Reuters.

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    Study details

    For the study, researchers presented 2,708 patients who were part of a registry of 140 cardiology, endocrinology, and primary care practices, with three hypothetical scenarios:

    • One in which their doctor told them they had a 15% risk of having a heart attack or stroke in the next decade;
    • Another in which their doctor told them they had a 4% risk of death in the next 10 years; and
    • A final scenario in which their doctor told them they had a 50% lifetime risk of having a stroke or heart attack.

    Each of the above scenarios was presented individually, though the researchers noted that they each describe the risks of an individual patient just presented in different ways.

    After hearing each scenario, patients were asked to rate the severity of the risk on a scale of very low, low, medium, high, or very high, as well as their willingness to take a medication that would reduce their risk by about one- third on a scale of very unwilling, slightly unwilling, possibly, somewhat willing, or very willing.

     When were patients most likely to take medication?

    For all three scenarios, the patients who perceived their risk as high or very high were two to three times more likely to say they were willing to take medication to lower their risk.  The researchers found:

    • 70.1% of patients rated a 50% lifetime risk of heart attack or stroke as "high to very high";
    • 31.4% of patients rated a 15% risk of heart attack in the next 10 years as "high to very high"; and
    • 25.7% of patients rated a 4% risk of death in the next 10 years as "high to very high."

    The researchers found that the way the patient's risk was presented correlated with how seriously they took the information. For example, the above data show patients were more likely to describe a risk as "high to very high" when they were given the risk over the course of their lifetimes, as opposed to over a 10-year period. The researchers hypothesized this could be because risk over an individual's lifetime is a larger number than the risk over a decade. 

    The researchers also found patients were more likely to rate the above scenarios as "high to very high" risk when the information was conveyed to them in either simple numbers or a bar graph.


    Anne Marie Navar, from the Duke Clinical Research Institute at Duke University Medical Center who was the lead author on the study, said the results of this study show that "[i]t matters how you show people what their risk is. Even the [graphical] tool you use can affect how high they see their risk to be."

    Some graphical tools, Navar said, might change how patients feel about the severity of their risk. "[I]f you're using a happy face diagram where a 15% risk is shown as 85 happy faces and 15 frowny faces, patients may see that as a lower risk than if you used a bar graph or just said the number," she said.

    Navar added that this study has led her to change how she talks with her patients about risks. "I make sure I give them both the 10-year and lifetime risks," she said. "I also make sure I explain my interpretation of those data."

    Jared Magnani, of the University of Pittsburgh Medical Center, said the study was "very important" because patients need to "understand the rationale for any type of pharmacologic intervention" for cardiovascular risk.

    Magnani also said the study "found that people had a pretty limited understanding of risk. So, they naturally tended to focus on the higher percentage number as conveying the higher level or risk no matter the scope of time. This suggests to me that we need a new vocabulary for communicating with patients" (Carroll, Reuters, 11/7).

    Help patients take an active role in their care

    Even the best care won't result in strong outcomes unless patients are ready and willing to follow care recommendations, make necessary lifestyle changes, and play an active role in managing their own care.

    That's why it's crucial that frontline clinicians have the skills to tap into patients' motivation to change. Our toolkit gives managers the resources they need to help clinicians do just that.

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