Cardiovascular disease risk prediction in older people: a qualitative study

BACKGROUND: Despite cardiovascular disease (CVD) risk prediction equations becoming more widely available for people aged ≥75 years, views of older people on CVD risk assessment are unknown. AIM: To explore older people’s views on CVD risk prediction and its assessment. DESIGN AND SETTING: Qualitative study of community-dwelling older people in New Zealand. METHOD: A diverse group of older people was purposively recruited. Semi-structured interviews and focus groups were conducted, transcribed verbatim, and thematically analysed. RESULTS: Thirty-nine participants (mean age 74 years) of Māori, Pacific, South Asian, and European ethnicities participated in one of 26 interviews or one of three focus groups. Three key themes emerged: poor knowledge and understanding of CVD and its risk assessment; acceptability and perceived benefit of knowing and receiving advice on managing personal CVD risk; and distinguishing between CVD outcomes — stroke and heart attack are not the same. Most participants did not understand CVD terms, but were familiar with the terms ‘heart attack’ and ‘stroke’, and understood lifestyle risk factors for these events. Participants valued CVD outcomes differently, fearing stroke and disability — which might adversely affect independence and quality of life — but were less concerned about a heart attack, which was perceived as causing less disability or swifter death. These findings and preferences were similar across ethnic groups. All but two participants wanted to know their CVD risk, how to manage it, and distinguish between CVD outcomes. Those who did not wish to know perceived this as something only their God could decide. CONCLUSION: To inform clinical decision making for older people, consideration of an individual’s wish to know their risk is important, and risk prediction tools should provide separate event types rather than just composite outcomes.