IntroductionTargeted advice is needed for patients at risk of heart disease.
Scare tactics may not be necessary when trying to get patients at risk of heart disease to change their diet or behaviour, a new study by Egenis research fellow Dr Hannah Farrimond has found. Instead, doctors and nurses should be aware of the stage of life their patients are at, and offer them very specific and targeted advice.
"The goal is to produce interventions which are sensitive to the lives and social position of those who find themselves at ‘high risk’ of coronary heart disease (CHD) in later-middle age, and which inspire change rather than inhibit it," says Dr Farrimond.
High-risk patients will often downgrade their risk in their own minds, yet could still be receptive to the behavioural change which is the purpose of CHD screening, explained Dr Farrimond, who studied the reaction of patients to being told they were at high risk. Boosting patients’ sense of vulnerability does not help, and may even hinder, their efforts to change, the study found.
"Once patients have got over the shock of being at high risk of heart disease, they then tend to underplay their risk," says Dr Farrimond. "They compare themselves favourably with, say, others of the same age. In the past, researchers have thought we need to scare people into feeling at risk to make them change. This study suggests that even those who downplayed their risk still made changes, such as taking statins or exercising more. In other words, we don’t need to scare people to get results. Clinical staff need to find other ways of encouraging patients to make the necessary lifestyle changes, such as offering personalised advice."
The findings of Dr Farrimond’s paper ‘Making sense of being at ‘high risk’ of coronary heart disease’, are published in the current issue of the journal Psychology and Health.
Current NHS policy advocates screening in primary care to identify ‘high risk’ individuals for coronary heart disease (CHD), particularly targeting those with family histories of the disease, through schemes such as the new, free ‘health MOT’ campaign. Until now, there has been little research looking at how people respond to such heart disease screening, particularly in relation to their age and stage of life. This study investigated the impact of the screening on the patients involved by interviewing 38 of them immediately after their intervention, looking particularly at how the age and stage of life of the participants affected their reactions.
"We found that patients struggled to maintain their sense of being ‘healthy’ in the face of their new ‘high risk’ status," said Dr Farrimond. "The older they were, the more patients treated the risk of CHD as a normal part of getting older. They would downplay their sense of vulnerability by, for example, comparing their own weight and diet favourably with that of their friends."
The study suggests that CHD intervention programmes need to be more sensitive to the social environment and age of the target group. It adds that most patients believe their diet is already ‘balanced’ or ‘healthy’, so clinicians should move away from simply repeating the formulaic set of well-known dietary rules and offering ‘added-value’ information about a specific CHD preventative diet.
"There’s no point in just telling patients to ‘be healthy’," said Dr Farrimond. "They need specific advice on how to protect their heart. GPs and nurses are well-placed to give the type of personalised information patients deserve."
‘Making sense of being at ‘high risk’ of heart disease’ is published in the journal Psychology and Health.‘Making sense of being at ‘high risk’ of coronary heart disease’ was part of the larger ADDFAM study, ‘Realising the potential of family history in risk assessment and primary prevention of coronary heart disease (CHD) in primary care’, led by Dr Nadeem Qureshi from the Primary Care Team at the University of Nottingham and carried out by Dr Hannah Farrimond and Dr Paula Saukko of Egenis and affiliated staff Philip Evans (Peninsula Medical School), Nottingham: Jo Middlemass (Researcher), Joe Kai, Sarah Armstrong, Tracey Sachs, Professor Steve Humphries, Cardiovascular Genetics, UCL, Dr Paula Yoon, Centers for Disease Control, USA. It was funded by the Department of Health.
The ADDFAM study was a quantitative randomised controlled trial with 24 practices in the South West and Nottingham. Twelve practices received risk calculations for patients without family history (controls) and six practices received risk calculations including family history (intervention). High risk participants were followed-up. Questionnaires assessing psychological and behavioural change were given at baseline, two weeks after results and six months later. Findings from this research are still being written up and will be published over the course of the next year.
‘Making sense of being at ‘high risk’ of coronary heart disease’ was a nested qualitative study. ‘High risk’ participants (n=38) were interviewed two weeks and six months after their initial clinical appointment. Six focus groups were also conducted with clinicians from the family history intervention practices.