Patient-Perceived Versus Actual Risk of Cardiovascular Disease and Associated Willingness to Consider and Use Prevention Therapy
Cardiovascular prevention guidelines use estimated 10-year atherosclerotic cardiovascular disease (CVD) risk based on the pooled cohort equations to guide treatment decisions and engage patients in shared decision-making. We sought to determine patient perceived versus actual risk of atherosclerotic...
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| Veröffentlicht in: | Circulation Cardiovascular quality and outcomes 2021-01, Vol.14 (1), p.e006548-e006548 |
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| container_title | Circulation Cardiovascular quality and outcomes |
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| creator | Navar, Ann Marie Wang, Tracy Y. Li, Shuang Mi, Xiaojuan Li, Zhuokai Robinson, Jennifer G. Virani, Salim S. Peterson, Eric D. |
| description | Cardiovascular prevention guidelines use estimated 10-year atherosclerotic cardiovascular disease (CVD) risk based on the pooled cohort equations to guide treatment decisions and engage patients in shared decision-making. We sought to determine patient perceived versus actual risk of atherosclerotic CVD and associations with willingness for preventive therapy.
We evaluated calculated and perceived CVD risk among 4187 patients across 124 sites in the Patient and Provider Assessment of Lipid Management Registry. Ten-year risk was assessed using the pooled cohort equations; risk relative-to-peers was determined based on age-, sex-, and race-based percentiles; and patient estimates of risk were assessed using patient surveys. Poisson regression models evaluated associations between risk estimates, statin use, and willingness to take prevention therapy.
Overall, there was no correlation between patients' estimates of their 10-year CVD risk and calculated 10-year risk (ρ=-0.01,
=0.46), regardless of age, sex, race, or socioeconomic status. The majority (72.2%) overestimated their 10-year CVD risk relative to the pooled cohorts equation (mean perceived 33.3% versus mean calculated 17.1%, |
| doi_str_mv | 10.1161/CIRCOUTCOMES.120.006548 |
| format | Article |
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We evaluated calculated and perceived CVD risk among 4187 patients across 124 sites in the Patient and Provider Assessment of Lipid Management Registry. Ten-year risk was assessed using the pooled cohort equations; risk relative-to-peers was determined based on age-, sex-, and race-based percentiles; and patient estimates of risk were assessed using patient surveys. Poisson regression models evaluated associations between risk estimates, statin use, and willingness to take prevention therapy.
Overall, there was no correlation between patients' estimates of their 10-year CVD risk and calculated 10-year risk (ρ=-0.01,
=0.46), regardless of age, sex, race, or socioeconomic status. The majority (72.2%) overestimated their 10-year CVD risk relative to the pooled cohorts equation (mean perceived 33.3% versus mean calculated 17.1%,
<0.01). Patients' perceptions of their risk relative-to-peers were slightly correlated with standardized risk percentiles (ρ=0.19,
<0.01), although most had overly optimistic views of how risk compared with their peers. Increasing perceived risk was not associated with current statin use (
=0.18) but was associated with willingness to consider future prevention therapy (
<0.01). Perceived risk relative-to-peers was associated with increased prevalent statin use (risk ratio 1.04 per category increase [95% CI, 1.02-1.06]) and reported willingness for prevention therapy (risk ratio 1.11 [95% CI, 1.07-1.16]).
When asked, most patients overestimate their 10-year risk but hold an optimistic bias of their risk relative to age-, race-, and sex-matched peers. Providing accurate absolute risk assessments to patients without proper context may paradoxically decrease many patients' perceived risk of CVD, thereby disincentivizing initiation of CVD risk reduction therapy.</description><identifier>ISSN: 1941-7705</identifier><identifier>ISSN: 1941-7713</identifier><identifier>EISSN: 1941-7705</identifier><identifier>DOI: 10.1161/CIRCOUTCOMES.120.006548</identifier><identifier>PMID: 33435730</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Aged ; Atherosclerosis ; Cardiovascular Diseases - diagnosis ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - prevention & control ; Cohort Studies ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Male ; Middle Aged ; Risk Assessment ; Risk Factors</subject><ispartof>Circulation Cardiovascular quality and outcomes, 2021-01, Vol.14 (1), p.e006548-e006548</ispartof><rights>American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4628-7fe0c5fb438cd80de260c4bd9a21bc68acb1409a6357d01afb3852735f1c8d753</citedby><cites>FETCH-LOGICAL-c4628-7fe0c5fb438cd80de260c4bd9a21bc68acb1409a6357d01afb3852735f1c8d753</cites><orcidid>0000-0001-9541-6954</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33435730$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Navar, Ann Marie</creatorcontrib><creatorcontrib>Wang, Tracy Y.</creatorcontrib><creatorcontrib>Li, Shuang</creatorcontrib><creatorcontrib>Mi, Xiaojuan</creatorcontrib><creatorcontrib>Li, Zhuokai</creatorcontrib><creatorcontrib>Robinson, Jennifer G.</creatorcontrib><creatorcontrib>Virani, Salim S.</creatorcontrib><creatorcontrib>Peterson, Eric D.</creatorcontrib><title>Patient-Perceived Versus Actual Risk of Cardiovascular Disease and Associated Willingness to Consider and Use Prevention Therapy</title><title>Circulation Cardiovascular quality and outcomes</title><addtitle>Circ Cardiovasc Qual Outcomes</addtitle><description>Cardiovascular prevention guidelines use estimated 10-year atherosclerotic cardiovascular disease (CVD) risk based on the pooled cohort equations to guide treatment decisions and engage patients in shared decision-making. We sought to determine patient perceived versus actual risk of atherosclerotic CVD and associations with willingness for preventive therapy.
We evaluated calculated and perceived CVD risk among 4187 patients across 124 sites in the Patient and Provider Assessment of Lipid Management Registry. Ten-year risk was assessed using the pooled cohort equations; risk relative-to-peers was determined based on age-, sex-, and race-based percentiles; and patient estimates of risk were assessed using patient surveys. Poisson regression models evaluated associations between risk estimates, statin use, and willingness to take prevention therapy.
Overall, there was no correlation between patients' estimates of their 10-year CVD risk and calculated 10-year risk (ρ=-0.01,
=0.46), regardless of age, sex, race, or socioeconomic status. The majority (72.2%) overestimated their 10-year CVD risk relative to the pooled cohorts equation (mean perceived 33.3% versus mean calculated 17.1%,
<0.01). Patients' perceptions of their risk relative-to-peers were slightly correlated with standardized risk percentiles (ρ=0.19,
<0.01), although most had overly optimistic views of how risk compared with their peers. Increasing perceived risk was not associated with current statin use (
=0.18) but was associated with willingness to consider future prevention therapy (
<0.01). Perceived risk relative-to-peers was associated with increased prevalent statin use (risk ratio 1.04 per category increase [95% CI, 1.02-1.06]) and reported willingness for prevention therapy (risk ratio 1.11 [95% CI, 1.07-1.16]).
When asked, most patients overestimate their 10-year risk but hold an optimistic bias of their risk relative to age-, race-, and sex-matched peers. Providing accurate absolute risk assessments to patients without proper context may paradoxically decrease many patients' perceived risk of CVD, thereby disincentivizing initiation of CVD risk reduction therapy.</description><subject>Aged</subject><subject>Atherosclerosis</subject><subject>Cardiovascular Diseases - diagnosis</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><issn>1941-7705</issn><issn>1941-7713</issn><issn>1941-7705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkV9v0zAUxSMEYmPwFcCPvKT4X2LnBakKAyYNtRotPFqOfbOauXFnJ532xkfHo2MqD5Yt3d8591inKN4RPCOkJh_ai6t2sV61i2_n32eE4hnGdcXls-KUNJyUQuDq-dH7pHiV0q_MMFqzl8UJY5xVguHT4vdSjw6GsVxCNOD2YNEPiGlKaG7GSXt05dINCj1qdbQu7HUyk9cRfXIJdAKkB4vmKQXj9Ji1P533brgeICU0BtSGITkL8S-2zvgywj5vc2FAqw1Evbt_XbzotU_w5vE-K9afz1ft1_Jy8eWinV-WhtdUlqIHbKq-40waK7EFWmPDO9toSjpTS206wnGj6_wvi4nuOyYrKljVEyOtqNhZ8fHgu5u6LViTU0Tt1S66rY73Kmin_p8MbqOuw14JWVUNbbLB-0eDGG4nSKPaumTAez1AmJKiXAje1EywjIoDamJIKUL_tIZg9dCfOu5P5f7Uob-sfHuc8kn3r7AM8ANwF_yYi7rx0x1EtQHtx43ChLGHECXFlGCCMS7zwZL9AbM2qwk</recordid><startdate>20210101</startdate><enddate>20210101</enddate><creator>Navar, Ann Marie</creator><creator>Wang, Tracy Y.</creator><creator>Li, Shuang</creator><creator>Mi, Xiaojuan</creator><creator>Li, Zhuokai</creator><creator>Robinson, Jennifer G.</creator><creator>Virani, Salim S.</creator><creator>Peterson, Eric D.</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9541-6954</orcidid></search><sort><creationdate>20210101</creationdate><title>Patient-Perceived Versus Actual Risk of Cardiovascular Disease and Associated Willingness to Consider and Use Prevention Therapy</title><author>Navar, Ann Marie ; Wang, Tracy Y. ; Li, Shuang ; Mi, Xiaojuan ; Li, Zhuokai ; Robinson, Jennifer G. ; Virani, Salim S. ; Peterson, Eric D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4628-7fe0c5fb438cd80de260c4bd9a21bc68acb1409a6357d01afb3852735f1c8d753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Atherosclerosis</topic><topic>Cardiovascular Diseases - diagnosis</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Navar, Ann Marie</creatorcontrib><creatorcontrib>Wang, Tracy Y.</creatorcontrib><creatorcontrib>Li, Shuang</creatorcontrib><creatorcontrib>Mi, Xiaojuan</creatorcontrib><creatorcontrib>Li, Zhuokai</creatorcontrib><creatorcontrib>Robinson, Jennifer G.</creatorcontrib><creatorcontrib>Virani, Salim S.</creatorcontrib><creatorcontrib>Peterson, Eric D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation Cardiovascular quality and outcomes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Navar, Ann Marie</au><au>Wang, Tracy Y.</au><au>Li, Shuang</au><au>Mi, Xiaojuan</au><au>Li, Zhuokai</au><au>Robinson, Jennifer G.</au><au>Virani, Salim S.</au><au>Peterson, Eric D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patient-Perceived Versus Actual Risk of Cardiovascular Disease and Associated Willingness to Consider and Use Prevention Therapy</atitle><jtitle>Circulation Cardiovascular quality and outcomes</jtitle><addtitle>Circ Cardiovasc Qual Outcomes</addtitle><date>2021-01-01</date><risdate>2021</risdate><volume>14</volume><issue>1</issue><spage>e006548</spage><epage>e006548</epage><pages>e006548-e006548</pages><issn>1941-7705</issn><issn>1941-7713</issn><eissn>1941-7705</eissn><abstract>Cardiovascular prevention guidelines use estimated 10-year atherosclerotic cardiovascular disease (CVD) risk based on the pooled cohort equations to guide treatment decisions and engage patients in shared decision-making. We sought to determine patient perceived versus actual risk of atherosclerotic CVD and associations with willingness for preventive therapy.
We evaluated calculated and perceived CVD risk among 4187 patients across 124 sites in the Patient and Provider Assessment of Lipid Management Registry. Ten-year risk was assessed using the pooled cohort equations; risk relative-to-peers was determined based on age-, sex-, and race-based percentiles; and patient estimates of risk were assessed using patient surveys. Poisson regression models evaluated associations between risk estimates, statin use, and willingness to take prevention therapy.
Overall, there was no correlation between patients' estimates of their 10-year CVD risk and calculated 10-year risk (ρ=-0.01,
=0.46), regardless of age, sex, race, or socioeconomic status. The majority (72.2%) overestimated their 10-year CVD risk relative to the pooled cohorts equation (mean perceived 33.3% versus mean calculated 17.1%,
<0.01). Patients' perceptions of their risk relative-to-peers were slightly correlated with standardized risk percentiles (ρ=0.19,
<0.01), although most had overly optimistic views of how risk compared with their peers. Increasing perceived risk was not associated with current statin use (
=0.18) but was associated with willingness to consider future prevention therapy (
<0.01). Perceived risk relative-to-peers was associated with increased prevalent statin use (risk ratio 1.04 per category increase [95% CI, 1.02-1.06]) and reported willingness for prevention therapy (risk ratio 1.11 [95% CI, 1.07-1.16]).
When asked, most patients overestimate their 10-year risk but hold an optimistic bias of their risk relative to age-, race-, and sex-matched peers. Providing accurate absolute risk assessments to patients without proper context may paradoxically decrease many patients' perceived risk of CVD, thereby disincentivizing initiation of CVD risk reduction therapy.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>33435730</pmid><doi>10.1161/CIRCOUTCOMES.120.006548</doi><orcidid>https://orcid.org/0000-0001-9541-6954</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1941-7705 |
| ispartof | Circulation Cardiovascular quality and outcomes, 2021-01, Vol.14 (1), p.e006548-e006548 |
| issn | 1941-7705 1941-7713 1941-7705 |
| language | eng |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Atherosclerosis Cardiovascular Diseases - diagnosis Cardiovascular Diseases - epidemiology Cardiovascular Diseases - prevention & control Cohort Studies Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Male Middle Aged Risk Assessment Risk Factors |
| title | Patient-Perceived Versus Actual Risk of Cardiovascular Disease and Associated Willingness to Consider and Use Prevention Therapy |
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