Background

There is substantial epidemiological evidence that supports identifying people at high risk of CVD and treating them with lifestyle and drug-based interventions. If fully implemented, this approach could reduce future CVD events by over 50%. Estimating the risk of CVD event such as a heart attack or stroke in the next five years is relatively easy using clinical decision support aids (paper-based or electronic). The hard part for doctors and nurses is explaining to patients what the concept of CVD risk means and use this to support patients to change 'risky' lifestyles and behaviour.

In 2008, Dr Sue Wells (Public Health Physician, University of Auckland) and Dr Andrew Kerr (Cardiologist, Counties Manukau District Health Board) came up with a novel approach to support CVD risk communication and behaviour change - the Heart Forecast.

This provides a graphical story:

• Starting with current CVD risk (where you are now)
• How you compare to a peer with ideal risk factor control and same CVD risk (your cardiovascular age)
• What happens to your risk as you get older if you make no changes (Your Heart Forecast), and
• What would happen to your risk in the future if you were able to make changes (e.g. stop smoking).

The Heart Forecast is simultaneously comprehensive and simple. It captures the short-term probability of an event for each individual together with arterial or cardiovascular age. These two metrics integrate both absolute and relative risk concepts. The tool then projects current risk into the future (The Heart Forecast) and dynamically graphs changes to CVD risk with changes in lifestyle both currently and into the future.

This approach is clearly unique. It was presented to, and enthusiastically endorsed, by the New Zealand Guidelines Group CVD guideline update committee and the Chair of the Cardiac Society. Following this, and in a collaborative partnership with the Heart Foundation, the Heart Forecast was developed into an electronic tool, able to be easily integrated into any GP electronic medical software, be accessible via the Heart Foundation website or be freely distributed as a CD.

The Heart Forecast was piloted in over 40 practices (from ProCare, Manaia, Te Tai Tokerau, Whangaroa, Kaipara Care, Tihewa Mauriora, Hauora Hokianga PHOs) in Auckland and Northland in March-April 2009. Feedback has been very positive and indicates that this tool significantly supports CVD risk communication and shared decision making. A concurrent evaluation assessing GP and practice nurse understanding of and confidence in explaining CVD risk is being undertaken and results will be available later in 2009. A further study investigating the impact on patients/consumers is planned.