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Monday, October 20, 2008
Columbus A-C (Hyatt Regency Penns Landing)
Purpose. One barrier to implementation of recommendations for cardiopreventive care is the discordance between actual cardiac risk and patients’ perceptions of risk. The aims of this study are: 1) to compare actual cardiovascular risk and risk perceptions in observation unit (OU) patients with possible acute coronary syndrome (ACS), and 2) to identify factors associated with perceived risk of ischemic heart disease (IHD) events in this population.
Methods. We conducted a baseline face-to-face interview of 83 adult OU patients with at least one modifiable CRF (smoking, hyperlipidemia, hypertension, diabetes mellitus, obesity) who received evaluation of ACS symptoms at 1 academic medical center and affiliated VA hospital. Only patients with an initially negative cardiac troponin measurement were eligible. We administered a modified questionnaire to capture health belief model constructs for IHD. To assess perceived risk, we asked: “How likely do you think it is that you will have a heart attack or die from coronary artery disease over the next 10 years? (response categories: <6, 6-9.9, 10-19.9, ³20%)” Actual risk group was determined by calculating Framingham Risk Score (FRS); patients with known IHD or diabetes mellitus were defined as high risk regardless of FRS. We used ordinal logistic regression to model perceived risk as a function of actual risk (FRS group) and covariates shown to be associated with perceived risk in the literature or in bivariate analyses.
Results. Of 78 OU patients with evaluable data, 38, 24, 16, and 22% perceived their cardiovascular risk to be low, intermediate, high, and very high, respectively. Nineteen percent overestimated and 41% underestimated their actual cardiovascular risk by at least 1 risk category. Patients at high actual risk of IHD events reported significantly greater perceived susceptibility to IHD and were more likely to attribute their acute symptoms to possible IHD (64 vs. 39%, p=.02). Ordinal regression revealed that FRS, family history, and depression were independently associated with perceived risk of adverse IHD-related events.
Conclusions. A large proportion of OU patients misestimate their long-term risk of IHD-related events. Perceived risk is determined by both actual “epidemiologic” risk and psychological factors such as depression. Systematic interventions to reduce discrepancies between actual and perceived risk of IHD-related outcomes may improve the uptake of preventive care recommendations, after these patients have been ruled out for ACS.
Methods. We conducted a baseline face-to-face interview of 83 adult OU patients with at least one modifiable CRF (smoking, hyperlipidemia, hypertension, diabetes mellitus, obesity) who received evaluation of ACS symptoms at 1 academic medical center and affiliated VA hospital. Only patients with an initially negative cardiac troponin measurement were eligible. We administered a modified questionnaire to capture health belief model constructs for IHD. To assess perceived risk, we asked: “How likely do you think it is that you will have a heart attack or die from coronary artery disease over the next 10 years? (response categories: <6, 6-9.9, 10-19.9, ³20%)” Actual risk group was determined by calculating Framingham Risk Score (FRS); patients with known IHD or diabetes mellitus were defined as high risk regardless of FRS. We used ordinal logistic regression to model perceived risk as a function of actual risk (FRS group) and covariates shown to be associated with perceived risk in the literature or in bivariate analyses.
Results. Of 78 OU patients with evaluable data, 38, 24, 16, and 22% perceived their cardiovascular risk to be low, intermediate, high, and very high, respectively. Nineteen percent overestimated and 41% underestimated their actual cardiovascular risk by at least 1 risk category. Patients at high actual risk of IHD events reported significantly greater perceived susceptibility to IHD and were more likely to attribute their acute symptoms to possible IHD (64 vs. 39%, p=.02). Ordinal regression revealed that FRS, family history, and depression were independently associated with perceived risk of adverse IHD-related events.
Conclusions. A large proportion of OU patients misestimate their long-term risk of IHD-related events. Perceived risk is determined by both actual “epidemiologic” risk and psychological factors such as depression. Systematic interventions to reduce discrepancies between actual and perceived risk of IHD-related outcomes may improve the uptake of preventive care recommendations, after these patients have been ruled out for ACS.
See more of: Poster Session II
See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)