Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects
BackgroundCardiovascular disease (CVD) risk communication is a challenge for clinical practice, where physicians find it difficult to explain the absolute risk of a CVD event to patients with varying health literacy. Converting the probability to heart age is increasingly use...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2021-11-01
|
| Series: | JMIR Cardio |
| Online Access: | https://cardio.jmir.org/2021/2/e31056 |
| _version_ | 1827858886397263872 |
|---|---|
| author | Carissa Bonner Carys Batcup Samuel Cornell Michael Anthony Fajardo Anna L Hawkes Lyndal Trevena Jenny Doust |
| author_facet | Carissa Bonner Carys Batcup Samuel Cornell Michael Anthony Fajardo Anna L Hawkes Lyndal Trevena Jenny Doust |
| author_sort | Carissa Bonner |
| collection | DOAJ |
| description |
BackgroundCardiovascular disease (CVD) risk communication is a challenge for clinical practice, where physicians find it difficult to explain the absolute risk of a CVD event to patients with varying health literacy. Converting the probability to heart age is increasingly used to promote lifestyle change, but a rapid review of biological age interventions found no clear evidence that they motivate behavior change.
ObjectiveIn this review, we aim to identify the content and effects of heart age interventions.
MethodsWe conducted a systematic review of studies presenting heart age interventions to adults for CVD risk communication in April 2020 (later updated in March 2021). The Johanna Briggs risk of bias assessment tool was applied to randomized studies. Behavior change techniques described in the intervention methods were coded.
ResultsFrom a total of 7926 results, 16 eligible studies were identified; these included 5 randomized web-based experiments, 5 randomized clinical trials, 2 mixed methods studies with quantitative outcomes, and 4 studies with qualitative analysis. Direct comparisons between heart age and absolute risk in the 5 web-based experiments, comprising 5514 consumers, found that heart age increased positive or negative emotional responses (4/5 studies), increased risk perception (4/5 studies; but not necessarily more accurate) and recall (4/4 studies), reduced credibility (2/3 studies), and generally had no effect on lifestyle intentions (4/5 studies). One study compared heart age and absolute risk to fitness age and found reduced lifestyle intentions for fitness age. Heart age combined with additional strategies (eg, in-person or phone counseling) in applied settings for 9582 patients improved risk control (eg, reduced cholesterol levels and absolute risk) compared with usual care in most trials (4/5 studies) up to 1 year. However, clinical outcomes were no different when directly compared with absolute risk (1/1 study). Mixed methods studies identified consultation time and content as important outcomes in actual consultations using heart age tools. There were differences between people receiving an older heart age result and those receiving a younger or equal to current heart age result. The heart age interventions included a wide range of behavior change techniques, and conclusions were sometimes biased in favor of heart age with insufficient supporting evidence. The risk of bias assessment indicated issues with all randomized clinical trials.
ConclusionsThe findings of this review provide little evidence that heart age motivates lifestyle behavior change more than absolute risk, but either format can improve clinical outcomes when combined with other behavior change strategies. The label for the heart age concept can affect outcomes and should be pretested with the intended audience. Future research should consider consultation time and differentiate between results of older and younger heart age.
International Registered Report Identifier (IRRID)NPRR2-10.1101/2020.05.03.20089938 |
| first_indexed | 2024-03-12T13:01:29Z |
| format | Article |
| id | doaj.art-75d610f7dbcb47a1a5bed9c90a98a921 |
| institution | Directory Open Access Journal |
| issn | 2561-1011 |
| language | English |
| last_indexed | 2024-03-12T13:01:29Z |
| publishDate | 2021-11-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Cardio |
| spelling | doaj.art-75d610f7dbcb47a1a5bed9c90a98a9212023-08-28T19:43:54ZengJMIR PublicationsJMIR Cardio2561-10112021-11-0152e3105610.2196/31056Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical EffectsCarissa Bonnerhttps://orcid.org/0000-0002-4797-6460Carys Batcuphttps://orcid.org/0000-0003-1896-533XSamuel Cornellhttps://orcid.org/0000-0003-4944-7826Michael Anthony Fajardohttps://orcid.org/0000-0002-1302-009XAnna L Hawkeshttps://orcid.org/0000-0002-4232-6127Lyndal Trevenahttps://orcid.org/0000-0003-1419-1832Jenny Dousthttps://orcid.org/0000-0002-4024-9308 BackgroundCardiovascular disease (CVD) risk communication is a challenge for clinical practice, where physicians find it difficult to explain the absolute risk of a CVD event to patients with varying health literacy. Converting the probability to heart age is increasingly used to promote lifestyle change, but a rapid review of biological age interventions found no clear evidence that they motivate behavior change. ObjectiveIn this review, we aim to identify the content and effects of heart age interventions. MethodsWe conducted a systematic review of studies presenting heart age interventions to adults for CVD risk communication in April 2020 (later updated in March 2021). The Johanna Briggs risk of bias assessment tool was applied to randomized studies. Behavior change techniques described in the intervention methods were coded. ResultsFrom a total of 7926 results, 16 eligible studies were identified; these included 5 randomized web-based experiments, 5 randomized clinical trials, 2 mixed methods studies with quantitative outcomes, and 4 studies with qualitative analysis. Direct comparisons between heart age and absolute risk in the 5 web-based experiments, comprising 5514 consumers, found that heart age increased positive or negative emotional responses (4/5 studies), increased risk perception (4/5 studies; but not necessarily more accurate) and recall (4/4 studies), reduced credibility (2/3 studies), and generally had no effect on lifestyle intentions (4/5 studies). One study compared heart age and absolute risk to fitness age and found reduced lifestyle intentions for fitness age. Heart age combined with additional strategies (eg, in-person or phone counseling) in applied settings for 9582 patients improved risk control (eg, reduced cholesterol levels and absolute risk) compared with usual care in most trials (4/5 studies) up to 1 year. However, clinical outcomes were no different when directly compared with absolute risk (1/1 study). Mixed methods studies identified consultation time and content as important outcomes in actual consultations using heart age tools. There were differences between people receiving an older heart age result and those receiving a younger or equal to current heart age result. The heart age interventions included a wide range of behavior change techniques, and conclusions were sometimes biased in favor of heart age with insufficient supporting evidence. The risk of bias assessment indicated issues with all randomized clinical trials. ConclusionsThe findings of this review provide little evidence that heart age motivates lifestyle behavior change more than absolute risk, but either format can improve clinical outcomes when combined with other behavior change strategies. The label for the heart age concept can affect outcomes and should be pretested with the intended audience. Future research should consider consultation time and differentiate between results of older and younger heart age. International Registered Report Identifier (IRRID)NPRR2-10.1101/2020.05.03.20089938https://cardio.jmir.org/2021/2/e31056 |
| spellingShingle | Carissa Bonner Carys Batcup Samuel Cornell Michael Anthony Fajardo Anna L Hawkes Lyndal Trevena Jenny Doust Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects JMIR Cardio |
| title | Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects |
| title_full | Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects |
| title_fullStr | Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects |
| title_full_unstemmed | Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects |
| title_short | Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects |
| title_sort | interventions using heart age for cardiovascular disease risk communication systematic review of psychological behavioral and clinical effects |
| url | https://cardio.jmir.org/2021/2/e31056 |
| work_keys_str_mv | AT carissabonner interventionsusingheartageforcardiovasculardiseaseriskcommunicationsystematicreviewofpsychologicalbehavioralandclinicaleffects AT carysbatcup interventionsusingheartageforcardiovasculardiseaseriskcommunicationsystematicreviewofpsychologicalbehavioralandclinicaleffects AT samuelcornell interventionsusingheartageforcardiovasculardiseaseriskcommunicationsystematicreviewofpsychologicalbehavioralandclinicaleffects AT michaelanthonyfajardo interventionsusingheartageforcardiovasculardiseaseriskcommunicationsystematicreviewofpsychologicalbehavioralandclinicaleffects AT annalhawkes interventionsusingheartageforcardiovasculardiseaseriskcommunicationsystematicreviewofpsychologicalbehavioralandclinicaleffects AT lyndaltrevena interventionsusingheartageforcardiovasculardiseaseriskcommunicationsystematicreviewofpsychologicalbehavioralandclinicaleffects AT jennydoust interventionsusingheartageforcardiovasculardiseaseriskcommunicationsystematicreviewofpsychologicalbehavioralandclinicaleffects |