Changing Use of Implantable Cardioverter Defibrillators (ICDs) in New Zealand from 2002 to 2012

Abstract

Background: New Zealand Cardiovascular disease (CVD) risk guidelines advocate targeted risk assessment with the intensity of management determined primarily on the estimated five-year CVD risk. However, clinicians often find it challenging to explain to patients what the conceptofCVDriskmeansanduse this to supportpatients to change ‘risky’ lifestyles and behaviour. “Your Heart Forecast” is a relatively simple dynamic graphical IT application that conveys multiple CVD risk communication messages individualised for each patient in a coherent story. It provides a graphical story at the time of consultation of current risk (where you are now), how you compare to a peer with ideal risk factor control, what happens to your risk as you get older if you make no changes (the Forecast), and what would happen to your risk in future if you were able to make changes (e.g. stop smoking). Our aim was to evaluate whether the Heart Forecast tool facilitated risk communication compared with a standard risk assessment session using the NZGG colour chart display. Methods and results: One hundred current smokers (age 30–65) without prior CVDwere enrolled in Southland primary care. Theywere randomised 1:1 to anurse-led risk assessment session with or without use of the Heart Forecast tool. Each patient had pre-assessment questionnaire, risk assessment session and same-day reassessment. The questionnaires evaluated patient understanding of the determinants of risk, their understanding of their own absolute short and longer-term CVD risk, and motivation to make lifestyle changes. Enrolment has been completed and resultswill be available for presentation.