Characteristics of studies
| Author and date | Study design | Country | Recipient of risk information | Control group | Intervention group | Risk score provided | Duration of follow up | Outcomes measured | Quality assessment* |
|---|---|---|---|---|---|---|---|---|---|
| Asimakopoulou (2008)20 | Before-after study | England | Patient | NA | Calculation of CVD/stroke risk followed by explanation of risk and discussion about difference between patients’ perception and actual risk | 1, 5 or 10 year UKPDS V.2.0 | 6 weeks | Understanding and recall of risk | L |
| Avis (1989)21 | RCT | USA | Patient | Baseline interview and assessment of perceived risk then follow-up interview at 7–12 weeks | Baseline interview, assessment of perceived risk and then health risk appraisal using one of four risk instruments and feedback on risk then follow-up interview at 7–12 weeks | CDC/HRA;37 The Heart Test;38 RISKO;39 Determine Your Medical Age40 | 7–12 weeks | Change in perceived risk | L |
| Christensen (1995)22 | Before-after study | Denmark | Patient | NA | Health examination with calculation of risk score and health talk with the GP | Risk of coronary artery disease41 | 6 months | Change in psychological well-being | L |
| Christensen (2004)23 | RCT | Denmark | Patient | Baseline questionnaire | Baseline questionnaire plus health screening with written feedback from their GPs and either optional or planned health discussions with their GP (2 intervention groups) | Risk of cardiovascular disease (modified from41) | 1 and 5 years | Change in psychological well-being | L-M |
| Connelly (1998)24 | Before-after study | UK | Patient | NA | Baseline questionnaire and screening appointment with provision of risk score. Participants at high risk were offered an appointment with a nurse or GP to discuss in more detail | 5-year risk of CHD based on Northwick Park Heart Study42 | 10 days and 3 months | Change in psychological well-being and anxiety | M-H |
| Hanlon (1995)25 | RCT | Scotland | Patient | Health education (interview backed up by written information) or health education and feedback on serum cholesterol | Health education plus feedback on risk score or health education and feedback on serum cholesterol plus feedback on risk score | Dundee risk score43 | 5 months | Self-reported change in diet, alcohol and smoking cessation, reduction in plasma cholesterol, and reduction in risk score | M |
| Hussein (2008)26 | Before-after study | USA | Patient | NA | Provision of 5-year CVD risk estimate in interview lasting approximately 5 min | 5-year Framingham risk | Immediate | Accuracy of risk perception | M |
| Paterson (2002)27 | Before-after study | Canada | Patient | NA | A consultation lasting approximately 18 min with a GP working through a workbook covering CHD and the concepts of risk and the patient's absolute and relative risk | 10-year risk of a coronary event based on Framingham Heart Study44 | Mean 12.8±13.1 days | Change in perceived risk | L |
| Persell (2013)28 | RCT | USA | Patient | Usual care | Patients were mailed a risk message containing their personal CVD risk information and encouraging them to discuss risk-lowering options with their primary care physician | 10-year Framingham risk score | 9 and 18 months | LDL cholesterol, BP, prescriptions for lipid-lowering or antihypertensive medication, smoking cessation and number of primary care physician contacts | M |
| Price (2011)29 | RCT | UK | Patient | Told their individual fasting glucose level, blood pressure and LDL cholesterol and whether they were elevated according to current guidelines±brief lifestyle advice intervention | A 10-year cardiovascular risk estimate for current risk and ‘achievable risk’ calculated assuming current targets for systolic BP, LDL cholesterol, HbA1c and smoking cessation were met±brief lifestyle advice intervention | 10 year UKPDS V.3.0 risk of cardiovascular disease | 1 month | Physical activity, 10-year CVD risk, weight, body fat percentage, BP, alcohol consumption, LDL, triglycerides, fructosamine, fasting glucose, 2 h glucose, vitamin C, cotinine, anxiety, quality of life, self-regulation, worry about future risk of heart attack, intention to increase physical activity and prescribing | M-H |
| Qureshi (2012)30 | Before-after study | UK | Patient | NA | Cardiovascular risk assessment then risk score along with lifestyle advice leaflet posted within 4 weeks. Participants with risk >20% offered appointment with their family physician or nurse 2 weeks later | 10-year JBS2 cardiovascular risk score | 6 months | Anxiety score, self-reported fat and unsaturated fat intake, smoking status and stage of change for increasing exercise | M |
| Bucher (2010)31 | RCT | Switzerland | Physician | Physicians received booklet of evidence-based guidelines for the management of CHD risk factors and were advised in the booklet to access a website for CHD risk assessment | Physicians received same booklet of evidence-based guidelines plus a risk profile for each patient on the patient charts | 10-year Framingham risk | 12–18 months | Change in total cholesterol, blood pressure, Framingham risk score and initiation of medication | H |
| Hall (2003)32 | RCT | Scotland | Physician | Usual care—physicians were unaware of ongoing study | Documentation of New Zealand Cardiovascular score at the front of medical records | 5-year cardiovascular risk from New Zealand Cardiovascular score45 | Not given | Change in prescribing for diabetes, hypertension or lipid-lowering drugs | M |
| Hanon (2000)33 | RCT | France | Physician | Baseline measurement of BP and prescription of fosinopril followed by visits at 4 and 8 weeks at which physicians could add in hydrochlorothiazide | As for control group plus calculation of Framingham risk also given to physicians | 10 year Framingham risk | 8 weeks | Change in blood pressure, number of patients with dual antihypertensive therapy and change in Framingham risk | M |
| Grover (2007)34 | RCT | Canada | Physician and patient | Physicians attended full-day educational session. Patients received usual care with follow-up at 2–4 weeks and 3,6,9 and 12 months | Physicians attended the same full-day educational session. Patients were given a copy of their risk profile and then followed up at 2–4 weeks, 3,6,9 and 12 months | 10-year Framingham risk | 12 months | Change in 10-year risk of CVD and probability of reaching lipid targets | M-H |
| Grover (2009)35 | RCT | Canada | Physician and patient | Physicians attended full-day educational session. Patients received usual care with follow-up at 2–4 weeks and 3,6,9 and 12 months | Physicians attended the same full-day educational session. Patients were given a copy of their risk profile and then followed up at 2–4 weeks, 3,6,9 and 12 months | 10-year Framingham risk | 12 months | Mean blood pressure threshold for intensifying antihypertensive treatment | M |
| Lowensteyn (1998)36 | RCT | Canada | Physician and patient | Physicians—1 h education meeting and a monthly newsletter. Patients—completed questionnaire about attitudes and knowledge surrounding CVD prevention and assessment of their current lifestyle and medical problems | Physicians—same 1 h education meeting and a monthly newsletter plus received 2 copies of patients risk profile within 10 working days. Patients—completed same questionnaire and then invited back 2 weeks later when presented with risk | 8-year coronary risk from CHD Prevention Model and estimated ‘cardiovascular age’ | 3–6 months | Patient/physician follow-up decisions and changes in smoking, cholesterol, BP, BMI, 8-year coronary risk and cardiovascular age | L |
*Low (L), medium (M), high (H).
BMI, body mass index; BP, blood pressure; CHD, coronary heart disease; CVD, cardiovascular disease; GP, general practitioner; HbA1c, glycated haemoglobin; LDL, low-density lipoprotein; NA, not available; RCT, randomised controlled trial.