Discussing lifetime vs. 10-year CVD risk estimates led to higher patient risk perception, willingness for therapy
Patients who were presented with cardiovascular disease (CVD) risk information using a pictogram had lower perception of risk and were less willing to consider therapy than those presented with a bar graph or no graphic at all.
The time-based outcome and format used to estimate and communicate atherosclerotic cardiovascular disease (ASCVD) risk may influence a patient's perception of risk and willingness to consider therapy, a recent study found.
From May 27 through Nov. 12, 2015, participants from the Patient and Provider Assessment of Lipid Management Registry seen at 140 cardiology, primary care, and endocrinology practices in the U.S. were asked to answer a series of questions about ASCVD risk based on a hypothetical patient with an elevated 10-year and lifetime risk. Participants were presented with three independent scenarios: 1) a 15% 10-year ASCVD event risk, 2) a 4% 10-year cardiovascular disease (CVD) death risk, and 3) a 50% lifetime ASCVD event risk. Researchers randomized participants to receive risk estimates using numbers only, a bar graph, or a face pictogram and assessed differences in risk perceptions and treatment preferences. Results were published online on Nov. 7 by JAMA Cardiology.
Overall, 3,566 participants were randomized to view survey questions with text alone (n=1,022 [28.7%]), with a bar graph (n=1,489 [41.8%]), and with face pictograms (n=1,046 [29.3%]). Of these, 858 (24.1%) participants skipped the risk questions or marked “I don't know” or “I don't understand,” for a final sample size of 2,708 respondents (median age, 67.0 years; 55.1% men).
When shown the lifetime ASCVD risk, participants were more likely to consider the risk “high to very high” than when presented with the 10-year ASCVD risk or the 10-year CVD death risk (70.1% vs. 31.4% vs. 25.7%, respectively; P<0.001 for both comparisons). Willingness to take medication to lower risk was also the highest for lifetime ASCVD risk (77.9% very willing), followed by 10-year ASCVD risk (68.1%), and 10-year CVD death risk (63.1%) (P<0.001 for both comparisons). For all three types of risk estimate horizons, participants who viewed risk information with a pictogram had the lowest perception of disease severity and were least willing to consider therapy compared with participants who viewed a bar graph or no graphic.
“Our data suggest that individuals are most affected by the estimate that produces the highest absolute number,” the study authors wrote. They added, “While pictograms may help individuals better understand the concept of a proportion, the number of ‘happy’ faces in the diagram may have led to qualitatively lower risk estimates.”
The authors noted limitations of the study, such as the fact that all participants received the same 10-year and lifetime hypothetical risk estimates, rather than personalized risk scores, and that willingness for therapy was evaluated based on a hypothetical medication that would lower risk by about a third, rather than a specific therapy. In addition, compared to respondents, participants who skipped the questions about risk had lower numeracy and education levels, higher age, and lower likelihood of having private insurance, which may limit the generalizability of the results, the authors said.