The Optimizing-Risk-Communication (OptRisk) randomized trial – impact of decision-aid-based consultation on adherence and perception of cardiovascular risk

Figures & data

Figure 1 Flowchart of participation.

Abbreviations: GP, general practitioner; TTE, time to event.

Table 1 Characteristics of the study population (n=294)

	Emoticons	Time to event	P-value
Age (years), mean (SD)	58.24 (10.61)	58.20 (10.90)	0.973
Immigrants, n (%)	10 (7.2)	13 (8.7)	0.669
Low level of education,a n (%)	65 (45.1)	64 (42.7)	0.725
Sex (male), n (%)	88 (61.1)	82 (54.7)	0.289
Known hypertension, n (%)	36 (25)	44 (29.3)	0.433
Total cholesterol >200 mg/dL, n (%)	98 (68.1)	112 (74.7)	0.245
HDL cholesterol <40 mg/dL, n (%)	25 (17.7)	20 (13.3)	0.418
Known diabetes, n (%)	43 (29.9)	40 (26.7)	0.605
Current smokers, n (%)	39 (27.1)	41 (27.3)	1
Male age >55 years/female age >65 years, n (%)	67 (46.5)	69 (46.0)	1
Known vascular disease,b n (%)	15 (10.6)	14 (9.3)	0.846
Family history of vascular disease,c n (%)	47 (32.6)	50 (33.3)	0.902
Hypertension medication, n (%)	83 (57.6)	73 (48.7)	0.130
Mean number of risk factors	3.11 (1.57)	3.05 (1.33)	0.703
GPs with Arriba experience, n (%)*	15 (10.4)	17 (11.3)	0.853
Numeracy (correct answers), mean (SD)	1.1 (0.80)	1.1 (0.84)	0.937

Notes:

a Defined as no general certificate of secondary education;

b evidence of coronary heart disease, stroke, or peripheral arterial occlusive disease;

c at least one first-degree relative with coronary heart disease before age 55 years (men) and 65 years (women);

* GPs had used Arriba.

Abbreviations: GP, general practitioner; HDL, high-density lipoprotein.

Figure 2 Frequency distribution of number of interventions discussed and agreed upon per patient per study arm.

Figure 3 Frequency distribution of adherence score per study arm.

Table 2 Mean adherence in relation to number of interventions discussed

	Interventions, n	Mean	n	SD	P-value*
Emoticons	1	0.85	33	0.57	0.025
	2	1.20	43	0.46
	3	1.04	35	0.34
	4	0.97	17	0.20
	5	1.08	11	0.24
	6	1.00	4	0.14
Time to event	1	1.19	32	0.59	0.210
	2	1.00	46	0.35
	3	1.01	30	0.27
	4	1.05	14	0.17
	5	0.87	9	0.20
	6	1.06	6	0.09

Note:

* Global value on ANOVA.

Table 3 Risk perception and self-rated importance of avoiding a cardiovascular event over time, depending on risk representation

	Mean	n	SD	P-value*
Emoticons
Risk perception at baseline	4.08	143	2.366	0.266
Risk perception at follow-up (3 months)	3.88	143	1.915
Importance at baseline	8.84	144	2.399	<0.0005
Importance at follow-up (3 months)	9.92	144	0.383
Time to event
Risk perception at baseline	5.14	146	2.805	0.002
Risk perception at follow-up (3 months)	4.40	146	2.043
Importance at baseline	9.05	147	1.975	<0.0005
Importance at follow-up (3 months)	9.81	147	0.612

Note:

* Paired t-tests.

Figure S1 TTE interface of Arriba decision aid.

Notes: (A) Medical history-taking. On the left, parameters of medical history must be filled in (top to bottom): sex, age, smoking status, presence of manifest arteriosclerosis, positive family history, taking of antihypertensive medications, systolic blood pressure, total cholesterol level, high-density-lipoprotein level, and presence of diabetes. On the right, the time-to-event (TTE) graph is displayed, accompanied by the information that “A 62-year-old man with the same risk profile could suffer a myocardial infarction or stroke on average 8 years from now (at 70 years of age)”. (B) Visualization of treatment options. On the left, the treatment options are shown (from top to bottom): behavioral changes, ie, smoking cessation, nutrition, and sports, and drug treatment, ie, statins, antihypertensive drugs, and aspirin. On the right, TTE graphs are displayed, accompanied by the information that “A 62-year-old treated man with the same risk profile could suffer a myocardial infarction or stroke on average 9 years from now (at 71 years of age)”. Risk reduction (here due to sports) is indicated with the orange timeline. Statistical information added: “35.8% of this group suffer a myocardial infarction or stroke”.

Figure S2 Emoticon interface of Arriba decision aid.

Notes: (A) Medical history-taking. On the left, parameters of medical history must be filled in (from top to bottom): sex, age, smoking status, presence of manifest arteriosclerosis, positive family history, taking of antihypertensive medications, systolic blood pressure, total cholesterol level, high-density-lipoprotein level, presence of diabetes, and HbA1c level. On the right, the emoticons are displayed, accompanied by the information that: “Of 100 men with the same risk profile, 25 will suffer a myocardial infarction or stroke within the next 10 years”. (B) Visualization of treatment options. On the left, treatment options are shown (from top to bottom): behavioral changes, ie, smoking cessation, nutrition, and sports, and drug treatment, ie, statins, antihypertensive drugs, aspirin, and metformin. On the right, the emoticons are displayed, accompanied by the information that: “Of 100 treated men with the same risk profile, 14 will suffer a myocardial infarction or stroke within the next 10 years”. Risk reduction (here due to nutrition modification and sports) is indicated with orange emoticons.

Availability of data and materials

All study data and materials are available upon request. This includes the study version of Arriba and specifications regarding the Markov model.