Evaluating the use of the heart age tool in community pharmacies: a 4-week cluster-randomized controlled trial

Svendsen, Karianne; Jacobs, David R.; Mørch-Reiersen, L.T.; Garstad, Kjersti W.; Henriksen, Hege Berg; Telle-Hansen, Vibeke H.; Retterstøl, Kjetil

doi:10.1093/eurpub/ckaa048

Cited by 7 publications

(21 citation statements)

References 31 publications

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“…Study details and outcomes are summarized by study category in Tables 1 - 3 . Multimedia Appendix 1 [ 23 - 32 ] provides details about the measures used in each study, and Multimedia Appendix 2 [ 14 , 23 - 37 ] provides details of behavior change techniques included in the control versus intervention groups.…”

Section: Resultsmentioning

confidence: 99%

“…When heart age was combined with additional strategies (eg, in person or phone counseling) in 5 applied trials [ 28 - 32 ] for 9582 patients, it improved risk control (eg, reduced cholesterol and absolute risk) compared with usual care in most trials (4/5, 80% of relevant studies) up to 1 year. However, the direction of outcomes (lifestyle, blood pressure, cholesterol, and weight) was the same for absolute risk and heart age groups in one trial that compared each group to usual care (1/1, 100% of relevant studies).…”

Section: Resultsmentioning

confidence: 99%

“…However, the direction of outcomes (lifestyle, blood pressure, cholesterol, and weight) was the same for absolute risk and heart age groups in one trial that compared each group to usual care (1/1, 100% of relevant studies). Follow-up periods ranged from 4 weeks to 12 months, and all trials used the US Framingham model for risk except Svendsen et al [ 32 ], which used the UK JBS-3 model. Lowensteyn et al [ 28 ] compared a paper-based risk profile intervention (8-year risk, cardiovascular age, effect of reducing risk factors) to usual care among 958 patients over 3 months and found no difference in blood pressure but lower cholesterol, leading to lower absolute risk.…”

Section: Resultsmentioning

confidence: 99%

“…They found higher use of cholesterol medication, lower cholesterol levels, and lower absolute risk in the heart age intervention group than in the control group; however, there was no difference in blood pressure or weight. Svendsen et al [ 32 ] compared conventional risk communication (risk categories, colors, evaluative labels, verbal and written advice) to the same information plus heart age among 257 patients visiting a pharmacy, and they found that although using heart age was popular among pharmacy staff, adding heart age was no more effective than conventional risk communication alone in changing physical activity or reducing cholesterol and blood pressure levels ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Risk of bias was noted for all randomized studies, with some applied clinical trials being particularly concerning in terms of unclear or questionable methods for randomization and analyses, including contamination between groups and analysis not per original randomized group. All experimental trials used self-reported outcomes rather than objective methods ( Figure 3 , [ 23 - 32 ]).…”

Section: Resultsmentioning

confidence: 99%

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Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects

Bonner¹,

Batcup²,

Cornell³

et al. 2021

JMIR Cardio

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Background Cardiovascular 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. Objective In this review, we aim to identify the content and effects of heart age interventions. Methods We 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. Results From 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. Conclusions The 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

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects

Bonner¹,

Batcup²,

Cornell³

et al. 2021

JMIR Cardio

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Cardiovascular disease risk communication and prevention: a meta-analysis

Bakhit,

Fien,

Abukmail

et al. 2024

European Heart Journal

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Background and Aims Knowledge of quantifiable cardiovascular disease (CVD) risk may improve health outcomes and trigger behavioural change in patients or clinicians. This review aimed to investigate the impact of CVD risk communication on patient-perceived CVD risk and changes in CVD risk factors. Methods PubMed, Embase, and PsycINFO databases were searched from inception to 6 June 2023, supplemented by citation analysis. Randomized trials that compared any CVD risk communication strategy versus usual care were included. Paired reviewers independently screened the identified records and extracted the data; disagreements were resolved by a third author. The primary outcome was the accuracy of risk perception. Secondary outcomes were clinician-reported changes in CVD risk, psychological responses, intention to modify lifestyle, and self-reported changes in risk factors and clinician prescribing of preventive medicines. Results Sixty-two trials were included. Accuracy of risk perception was higher among intervention participants (odds ratio = 2.31, 95% confidence interval = 1.63 to 3.27). A statistically significant improvement in overall CVD risk scores was found at 6–12 months (mean difference = −0.27, 95% confidence interval = −0.45 to −0.09). For primary prevention, risk communication significantly increased self-reported dietary modification (odds ratio = 1.50, 95% confidence interval = 1.21 to 1.86) with no increase in intention or actual changes in smoking cessation or physical activity. A significant impact on patients’ intention to start preventive medication was found for primary and secondary prevention, with changes at follow-up for the primary prevention group. Conclusions In this systematic review and meta-analysis, communicating CVD risk information, regardless of the method, reduced the overall risk factors and enhanced patients’ self-perceived risk. Communication of CVD risk to patients should be considered in routine consultations.

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Prevalence of dyslipidemia and hypercholesterolemia awareness: results from the Lookup 7+ online project

Martone

Landi

Petricca

et al. 2022

European Journal of Public Health

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Background Cardiovascular disease still represents the leading cause of death worldwide. Management of risk factors remains crucial; despite this, hypercholesterolemia, which is one of the most important modifiable cardiovascular risk factor, is still high prevalent in general population. The aim of this study is to determine the prevalence of dyslipidemia and hypercholesterolemia awareness in a very large population. Methods More than 65 000 users completed the online, self-administered survey. It was structured like a ‘journey’ where each stage corresponded to a cardiovascular risk factor: blood pressure, body mass index, cholesterol, diet, physical exercise, smoke and blood sugar. At the end, the user received a final evaluation of his health status. Results The mean age was 52.5 years (SD 13.9, range 18–98), with 35 402 (53.7%) men. About 56% of all participants believed to have normal cholesterol values, when only 40% of them really showed values <200 mg/dl. Only about 30% of all participants self-predicted to have abnormal cholesterol values whereas we found high cholesterol levels in about 60% of people. Conclusions Dyslipidemia is very prevalent and half of the people with high cholesterol is not aware of having high values.

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Evaluating the use of the heart age tool in community pharmacies: a 4-week cluster-randomized controlled trial

Cited by 7 publications

References 31 publications

Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects

Interventions Using Heart Age for Cardiovascular Disease Risk Communication: Systematic Review of Psychological, Behavioral, and Clinical Effects

Cardiovascular disease risk communication and prevention: a meta-analysis

Prevalence of dyslipidemia and hypercholesterolemia awareness: results from the Lookup 7+ online project

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