Title : Low subjective cardiovascular disease risk perceptions among hypertensive patients in Addis Ababa, Ethiopia.
Background: Accurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients’ risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS).
Methods: A cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants’ risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level.
Results: Participants (n=377) had a mean age of 53.61 ± 12.80-years, range (18-82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43 – 18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36 - 14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants’ CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation.
Conclusion: Hypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients’ CVD risk perception to reduce adverse CVD events.
Audience Take Away Notes:
• Why it is so important to recognize the serious and life-threatening adverse cardiovascular disease outcomes such as stroke and acute myocardial infarction in relation to uncontrolled hypertension, and its growing impacts in low and middle-income countries in particular
• Patients’ inaccurate risk perceptions may hinder them from taking measures that reduce adverse cardiovascular events, and the need for periodic risk perception assessment and stratification to guide treatment to adverse cardiovascular events
• The available alternative objective measure (the non-laboratory-based Framingham Risk Score) to predict patients at higher risk for cardiovascular events and guide treatment initiation to prevent adverse events in low-resource clinical settings
• Faculties of teaching and research institutions can largely replicate this research