Low Subjective Cardiovascular Disease Risk Perceptions among Hypertensive Patients in Addis Ababa, Ethiopia

Abstract

Background Accurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients’ risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS). Methods A cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants’ risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level. Results Participants (n=377) had a mean age of 53.61 ± 12.80-years, range (18–82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43–18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36–14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants’ CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation. Conclusion Hypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients’ CVD risk perception to reduce adverse CVD events.

Community perception of causes of death using verbal autopsy for diabetes mellitus in Saudi Arabia

“…Although this may seem plausible from a medical point of view, failing to recognize symptoms of common illnesses can have some public health implications since most deaths have taken place at hospital settings where relatives or caregivers are presumably informed about the illness of their deceased. This was also observed in other cross-sectional studies linking low health literacy skills with unrealistic risk underestimation [ 70 , 71 ]. Another plausible explanation is that circulatory diseases are frequently asymptomatic, with risk factors slowly progressing over time, leading to delayed recognition and perception.…”

Dying to make a care policy: Community perception of causes of deaths using standardized verbal autopsy method: Saudi type 2 diabetes mellitus register data

“…Although this may seem plausible from a medical point of view, failing to recognize symptoms of common illnesses can have some public health implications since most deaths have taken place at hospital settings where relatives or caregivers are presumably informed about the illness of their deceased. This was also observed in other cross-sectional studies linking low health literacy skills with unrealistic risk underestimation [62,63]. Another plausible explanation is that circulatory diseases are frequently asymptomatic with risk factors slowly progressing over time leading to delayed recognition and perception.…”

Cross Validation of the Post Event-Cardiovascular Risk Perception Survey Instrument among Cardiac Rehabilitation Patients

“…Similar to authors, Amini et al and Percy et al, there is value in using the PE-CRPS to patients who already have a history of heart disease [28][29]. Those with a history of heart disease should not be ignored when it comes to estimating their added risk and should be encouraged to change behaviors in order to prevent further development of CVD [25,32]. The PE-CRPS is a validated tool that can be adopted to influence and promote healthy education and quality of life among patients with known heart disease or those who experienced a cardiac event.…”

“…The pandemic has in some sense delayed cardiac rehabilitation standard of care for patients who have experienced post cardiac events such as open-heart surgery, myocardial infarction, stroke and other events [28][29]. The challenge between underestimation of perceived risk for heart disease and delayed care for patients with known heart disease is important because engaging patients with already known heart disease can promote healthy behaviors and lifestyle modifications even after having a post cardiac event [14,25,[30][31][32][33][34]. Cardiac rehabilitation has demonstrated value in engaging patients in a formal exercise program, health promotion education and improving quality of life [20,[35][36][37][38].…”