| CVD Risk Guideline
4. Communicate CVD risk
|Certainty of evidence
|Use a relevant decision aid to support effective risk
communication and enable informed decisions about
reducing CVD risk.
|Combine risk communication tools with behavioural
strategies (e.g. motivational interviewing,
personalised goal setting and health coaching), repeated over time, to reduce overall CVD risk.
|Communicate CVD risk using a variety of formats (e.g.
percentages, 100-person charts) to enable people with
varying health literacy needs and learning styles to
understand their risk.
Communicating risk is essential for informed consent and shared decision-making.
Effective communication should also be part of careful support to reduce CVD risk through lifestyle modifications and prescribing medicines, considering the person’s preferences and understanding of their health status.
Risk communication is most effective when the practitioner understands the person, their health literacy, and their social and cultural background, and tailors messages accordingly.
Evidence from other areas of health care supports the principle that healthcare providers should consider people’s diverse and often changing health literacy needs and learning styles when communicating risk.6
Be aware that an understanding of CVD risk varies from person to person, including what is and is not a risk factor, and the relationship between CVD risk factors and reducing risk or managing their condition.
When communicating risk:
- Communicate risk as either a percentage or as a frequency (e.g. 15% or “15 out of 100 people like you will have a heart attack or stroke in the next 5 years”).134,135
- Consider the person’s receptivity, understanding and acceptance of risk, health literacy, and learning preferences.
- Provide the information in multiple formats (e.g. numerical percentage, 100-person charts) suitable for the person’s receptivity and understanding.
- Use relevant decision aids to improve knowledge and guide management discussions.
- Repeat this discussion about risk over several consultations, where appropriate.
- Emphasise the relevance of the information by relating it to aspects of the person’s own experiences such as a recent illness, a new diagnosis in a friend or family member, the person’s life stage (e.g. adulthood, pregnancy), or family medical history.
- Discuss relevant CVD risk factors such as smoking, alcohol intake or obesity.
- It may be more effective to emphasise the benefits of treatment and lifestyle* modification to reducing risk, rather than focusing on negative health outcomes.
- Ensure that people with limited health literacy receive information they can easily understand and act upon, considering cultural and linguistic diversity and socioeconomic situation.
- Communicate risk in a culturally safe way. Where appropriate, engage with the person’s family members, carers and other members of their community (e.g. community navigators), to help communicate risk information effectively and safely to people whose culture or language is different from your own.
- Consider and communicate the need to refer to other healthcare professionals to support the person in addressing their risk.
First Nations people
There is substantial burden of CVD within some First Nations families and communities. In some instances, this can result in perceptions that developing CVD is inevitable.136
Effectively communicating CVD risk and how to respond to risk is important for First Nations communities; literature demonstrates that poor understanding affects risk management.136-139
Having a positive, trusting relationship with a health practitioner and health service is important for supporting First Nations people receiving CVD risk assessment and management.138-142
It is important that a conversation about risk involves identifying and supporting positive actions to reduce risk.
When communicating risk with First Nations people consider (in addition to the practice advice above):
- First Nations concepts of health and wellbeing differ from the Western biomedical model of health
- Engaging an Aboriginal health practitioner/worker to optimise a conversation about risk
- The person’s primary language, and engage an interpreter as required
- Using First Nations specific risk communication tools where relevant and available.
- Cardiovascular disease risk communication with Aboriginal and Torres Strait Islander Peoples: Toolkit for health professionals - ANU Healthy Heart Communities project
Support for the recommendations
Evidence from four randomised controlled trials (RCTs) suggests that effectively communicating CVD risk may lead to behaviour changes that result in an improvement in predicted CVD risk assessed after 12 months.143
A 2021 systematic review found that using ‘heart age’ did not appear to motivate lifestyle behaviour change more than communicating CVD risk, but found that either approach can improve clinical outcomes when combined with other behaviour change strategies.144
Studies of repeated risk information, or risk information and repeated counselling, showed small reductions (up to 2%) in predicted CHD risk over 10 years. However, studies in which CHD risk was communicated only once seemed to be ineffective in improving knowledge, heart health management or risk.143
Systematic reviews have found that decision aids can lead to improved knowledge, compared with usual care.145 However, this evidence is mainly from studies focusing on conditions other than CVD.
Heart health check toolkit - National Heart Foundation of Australia
- Risk communication toolkit - The American College of Cardiology
- Communicating cardiovascular risk effectively - bpacNZ
- Risk communication online training module for health professionals - The Australian Commission on Safety and Quality in Health Care
- Yarning to make health decisions together – the Find Your Way shared decision-making model - Agency for Clinical Innovation
* This guideline refers to certain modifiable risk factors as ‘lifestyle’ factors. However, it is recognised that these behaviours are not necessarily an individual’s choice, but reflect the complex interplay of social, cultural, and environmental factors, which may be further influenced by clinical conditions. Use of the term ‘lifestyle’ does not attribute blame to a person.
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3a. Reclassification factors & other considerations
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5. Manage CVD Risk