Is the “Heart Age” Concept Helpful or Harmful Compared to Absolute Cardiovascular Disease Risk? An Experimental Study

Bonner, Carissa; Jansen, Jesse; Newell, Ben R.; Irwig, Les; Teixeira‐Pinto, Armando; Glasziou, Paul; Doust, Jenny; McKinn, Shannon; McCaffery, Kirsten

doi:10.1177/0272989x15597224

Cited by 34 publications

(50 citation statements)

References 37 publications

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“…They are also consistent to a large extent with a previous qualitative study that found that heart age can motivate lifestyle change [27]. We did not find decreased perceived credibility to this format of presentation of risk scores reported by that and other study [26], although if much higher than the actual age, ‘heart age’, like the genetic risk scores, can lead to some fatalistic views about CVD risk.…”

Section: Discussionsupporting

confidence: 92%

“…One recent randomised controlled trial found ‘heart age’ to be more effective than other types of individual’s modelled CVD risk in reducing risk scores [24]. Two studies, one experimental [26] and one qualitative [27] have found decreased perceived credibility for risk scores presented in this way, although the latter found it could still motivate lifestyle change. With increasingly available genetic data it has also been suggested that CVD risk information might be more effective when based on genetic information [28–30].…”

Section: Introductionmentioning

confidence: 99%

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The response to receiving phenotypic and genetic coronary heart disease risk scores and lifestyle advice – a qualitative study

et al. 2016

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BackgroundIndividuals routinely receive information about their risk of coronary heart disease (CHD) based on traditional risk factors as part of their primary care. We are also able to calculate individual’s risk of CHD based on their genetic information and at present genetic testing for common diseases is available to the public. Due to the limitations in previous studies further understanding is needed about the impact of the risk information on individual’s well-being and health-behaviour. We aimed to explore the short term response to receiving different forms of CHD risk information and lifestyle advice for risk reduction.MethodsWe conducted fourty-one face-to-face interviews and two focus groups across England with participants from the INFORM trial who received a combination of individualised phenotypic and genotypic CHD risk scores and web-based lifestyle advice. Risk scores were presented in different formats, e.g. absolute 10 year risk was presented as a thermometer and expressed as a percentage, natural frequency and ‘heart age’. Interviews and focus groups explored participants’ understanding and reaction to the risk scores and attempts to change lifestyle during the intervention. We tape-recorded and transcribed the interviews and focus groups and analysed them using thematic analysis.ResultsThree main themes were identified: limitations of risk scores to generate concern about CHD risk; the advantages of the ‘heart age’ format of risk score presentation in communicating a message of sub-optimal lifestyle; and intentions and attempts to make moderate lifestyle changes which were prompted by the web-based lifestyle advice.ConclusionsThere are a number of limitations to the use of risk scores to communicate a message about the need for a lifestyle change. Of the formats used, the ‘heart age’, if noticed, appears to convey the most powerful message about how far from optimal risk an individual person is. An interactive, user friendly, goal setting based lifestyle website can act as a trigger to initiate moderate lifestyle changes, regardless of concerns about risk scores.Trial registrationCurrent Controlled Trials ISRCTN17721237. Registered 12 January 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3867-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The response to receiving phenotypic and genetic coronary heart disease risk scores and lifestyle advice – a qualitative study

et al. 2016

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“…Four RCTs looked at the effect of heart age/cardiovascular age on patient behaviour. Bonner et al 16 showed that at 2 weeks after intervention, there was a positive change in lifestyle. The control group, who were told absolute cardiovascular risk, had a 15% smoking cessation rate.…”

Section: Resultsmentioning

confidence: 99%

“…This was mostly due to the heterogeneity of the recruitment, measurements of patient behaviour and the use of different age calculators. Recruitment included GP practices,15 18 20 Foulds 2015 19 college campuses (Lipkus 2007), online access research panels (Souretti 2010, Dammon OC 2018), market research company recruitment,16 smoking cessation clinics,21 25 hospital records (Drummond 2014,22) employee from recycling company,26 telephone directory24 and Spanish public health workers 17. Therefore, a meta-analysis could not be performed on the data.…”

Section: Discussionmentioning

confidence: 99%

How effective are ‘age’ tools at changing patient behaviour? A rapid review

Kulendrarajah

Grey

Nunan

2019

BMJ EBM

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BackgroundA common form of risk communication is to relay the relative risk (%) of an adverse outcome based on surrogate markers associated with the outcome. A novel way of communicating risk is through ‘effective age’ of a person or specific organ. These tools can be used to change patient behaviour.ObjectiveTo determine the effect of ‘effective age’ tools on patient behaviour as compared with more traditional methods of risk communication.Study selectionWe performed a search of the PubMed database up to February 2019 for systematic reviews and randomised controlled trials (RCT) that answered our question. Interventions were ‘effective age’ tools, comparators were usual care or alternative risk communication tools. Primary outcomes were behavioural change measures.FindingsWe included 1 overview of systematic reviews (level 1 evidence), 2 systematic reviews (level 1 evidence) and 13 RCTs (level 2 evidence). Both systematic reviews concluded the evidence base was not conclusive enough to make specific recommendations.Age tools assessed in the 13 RCTs were: ‘lung age’ (n=5), ‘heart age’ (n=3), ‘health age’ (n=2), ‘cardiovascular age’ (n=1), ‘body age’ (n=1) and ‘net present value’ (n=1). 7/13 (54%) RCTs demonstrated a clinical effect on behaviour change favouring the ‘age’ tool; 2/13 (15%) demonstrated a null effect; 4/13 (31%) favoured control.ConclusionsOur findings indicate that systematic review evidence needs updating. The evidence from RCTs on the effect of using age metrics on patient behaviour is poor. There is a need for high-quality trials to decrease uncertainty in the available evidence.

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“…These findings are compatible with previous research on the meaning of risk in CVD and other health areas. In CVD, previous studies have found more engagement and emotional reactions to salient risk formats such as heart age [28,29], but this may be counteracted by questioning risk results that don't match expectations [11,30]. Subjective perceptions of the need for medication may be focused on treating individual risk factors [31] and do not necessarily match actual estimates of CVD event reduction.…”

Section: Discussionmentioning

confidence: 96%

Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms?

Bonner

McKinn

Lau

et al. 2018

Patient Education and Counseling

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Is the “Heart Age” Concept Helpful or Harmful Compared to Absolute Cardiovascular Disease Risk? An Experimental Study

Abstract: Background: Cardiovascular disease (CVD) prevention guidelines are generally based on the absolute

Cited by 34 publications

References 37 publications

The response to receiving phenotypic and genetic coronary heart disease risk scores and lifestyle advice – a qualitative study

The response to receiving phenotypic and genetic coronary heart disease risk scores and lifestyle advice – a qualitative study

How effective are ‘age’ tools at changing patient behaviour? A rapid review

Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms?

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