Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
Primary Care Clinical Unit, University of Queensland, Brisbane, Australia.
Br J Gen Pract. 2021 Sep 30;71(711):e772-e779. doi: 10.3399/BJGP.2020.1038. Print 2021 Oct.
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.
To explore older people's views on CVD risk prediction and its assessment.
Qualitative study of community-dwelling older people in New Zealand.
A diverse group of older people was purposively recruited. Semi-structured interviews and focus groups were conducted, transcribed verbatim, and thematically analysed.
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.
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.
尽管心血管疾病（CVD）风险预测方程在≥75 岁的人群中应用越来越广泛，但老年人对 CVD 风险评估的看法尚不清楚。
探讨老年人对 CVD 风险预测及其评估的看法。
新西兰社区居住的老年人的定性研究。
通过有目的的方式招募了不同种族的老年人。进行了半结构式访谈和焦点小组讨论，逐字转录，并进行主题分析。
39 名参与者（平均年龄 74 岁）具有毛利人、太平洋岛民、南亚裔和欧洲裔等不同种族背景，参加了 26 次访谈中的一次或三次焦点小组中的一次。出现了三个关键主题：对 CVD 及其风险评估的了解和理解不足；了解和接受个人 CVD 风险管理建议的可接受性和潜在益处；区分 CVD 结果——中风和心脏病发作并不相同。大多数参与者不理解 CVD 术语，但熟悉“心脏病发作”和“中风”这两个术语，并且了解这些疾病的生活方式风险因素。参与者对 CVD 结果的重视程度不同，担心中风和残疾——这可能会对独立性和生活质量产生不利影响——但对心脏病发作的担忧较少，因为心脏病发作被认为不会造成太大的残疾或死亡更快。这些发现和偏好在不同种族群体中相似。除了两名参与者外，所有参与者都希望了解自己的 CVD 风险、如何管理风险以及区分 CVD 结果。那些不想了解的人认为这是只有他们的上帝才能决定的事情。
为了为老年人提供临床决策依据，考虑个人了解风险的意愿很重要，并且风险预测工具应提供单独的事件类型，而不仅仅是复合结果。
