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Is the "Heart Age" Concept Helpful or Harmful Compared to Absolute Cardiovascular Disease Risk? An Experimental Study
Carissa Bonner1,2, Jesse Jansen1,2, Ben R Newell3
1Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia (CB, JJ, LI, ATP, PG, JD, SM, KM)
Insights
Heart age does not motivate lifestyle changes better than 5-year absolute risk for individuals with low cardiovascular disease risk. Absolute risk is more credible and aligns with clinical guidelines for better risk communication.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Psychology
Background:
- Cardiovascular disease (CVD) prevention typically relies on absolute risk assessment.
- Heart age is a novel metric proposed to enhance patient motivation for lifestyle changes, particularly when absolute risk is low.
- Previous research has not directly compared heart age to 5-year absolute risk or explored the impact of presentation formats on outcomes.
Purpose of the Study:
- To compare the effectiveness of heart age versus 5-year absolute risk in influencing psychological and behavioral outcomes related to CVD risk.
- To investigate how different graphical formats and numeracy impact the understanding and perception of CVD risk communication.
Main Methods:
- A 2x3 experimental design was employed, comparing heart age and 5-year absolute risk across text-only, bar graph, and line graph formats.
- 570 Australians aged 45-64 without CVD medication were recruited for an online study.
- Outcomes measured included intention to change lifestyle, risk perception, emotional response, credibility, and actual lifestyle behaviors after a 2-week follow-up.
Main Results:
- Heart age did not significantly improve lifestyle intentions or behaviors compared to absolute risk among low-risk individuals.
- Low-risk participants were more likely to perceive heart age as indicating higher risk (47% vs. 23%) and reported decreased credibility and positive emotional responses.
- While recall of heart age was better at 2 weeks (32% vs. 16%), overall correct recall significantly dropped from 65% to 24% for all risk communication methods.
Conclusions:
- Heart age does not demonstrate superior motivational capacity over 5-year absolute risk for individuals with low CVD risk.
- Five-year absolute risk appears to be a more effective communication tool, enhancing credibility, avoiding risk inflation, and aligning with established clinical guidelines.
- Further research may be needed to explore CVD risk communication in clinical settings, as online delivery may yield different results.
Background:
Cardiovascular disease (CVD) prevention guidelines are generally based on the absolute risk of a CVD event, but there is increasing interest in using 'heart age' to motivate lifestyle change when absolute risk is low. Previous studies have not compared heart age to 5-year absolute risk, or investigated the impact of younger heart age, graphical format, and numeracy.
Objective:
Compare heart age versus 5-year absolute risk on psychological and behavioral outcomes.
Design:
2 (heart age, absolute risk) × 3 (text only, bar graph, line graph) experiment.
Setting:
Online.
Participants:
570 Australians aged 45-64 years, not taking CVD-related medication.
Intervention:
CVD risk assessment.
Measurements:
Intention to change lifestyle, recall, risk perception, emotional response, perceived credibility, and lifestyle behaviors after 2 weeks.
Results:
Most participants had lifestyle risk factors (95%) but low 5-year absolute risk (94%). Heart age did not improve lifestyle intentions and behaviors compared to absolute risk, was more often interpreted as a higher-risk category by low-risk participants (47% vs 23%), and decreased perceived credibility and positive emotional response. Overall, correct recall dropped from 65% to 24% after 2 weeks, with heart age recalled better than absolute risk at 2 weeks (32% vs 16%). These results were found across younger and older heart age results, graphical format, and numeracy.
Limitations:
Communicating CVD risk in a consultation rather than online may produce different results.
Conclusions:
There is no evidence that heart age motivates lifestyle change more than 5-year absolute risk in individuals with low CVD risk. Five-year absolute risk may be a better way to explain CVD risk, because it is more credible, does not inflate risk perception, and is consistent with clinical guidelines that base lifestyle and medication recommendations on absolute risk.
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