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BackgroundHeart age calculators are used worldwide to engage the public in cardiovascular disease (CVD) prevention. Experimental studies with small samples have found mixed effects of these tools, and previous reports of population samples that used web-based heart age tools have not evaluated psychological and behavioral outcomes. ObjectiveThis study aims to report on national users of the Australian heart age calculator and the follow-up of a sample of users. MethodsThe heart age calculator was launched in 2019 by the National Heart Foundation of Australia. Heart age results were calculated for all users and recorded for those who signed up for a heart age report and an email follow-up over 10 weeks, after which a survey was conducted. CVD risk factors, heart age results, and psychological and behavioral questions were analyzed using descriptive statistics and chi-square tests. Open responses were thematically coded. ResultsThere were 361,044 anonymous users over 5 months, of which 30,279 signed up to receive a heart age report and 1303 completed the survey. There were more women (19,840/30,279, 65.52%), with an average age of 55.67 (SD 11.43) years, and most users knew blood pressure levels (20,279/30,279, 66.97%) but not cholesterol levels (12,267/30,279, 40.51%). The average heart age result was 4.61 (SD 4.71) years older than the current age, including (23,840/30,279, 78.73%) with an older heart age. For the survey, most users recalled their heart age category (892/1303, 68.46%), and many reported lifestyle improvements (diet 821/1303, 63.01% and physical activity 809/1303, 62.09%). People with an older heart age result were more likely to report a doctor visit (538/1055, 51.00%). Participants indicated strong emotional responses to heart age, both positive and negative. ConclusionsMost Australian users received an older heart age as per international and UK heart age tools. Heart age reports with follow-up over 10 weeks prompted strong emotional responses, high recall rates, and self-reported lifestyle changes and clinical checks for more than half of the survey respondents. These findings are based on a more engaged user sample than previous research, who were more likely to know blood pressure and cholesterol values. Further research is needed to determine which aspects are most effective in initiating and maintaining lifestyle changes. The results confirm high public interest in heart age tools, but additional support is needed to help users understand the results and take appropriate action.

Background: A new Australian guideline for cardiovascular disease (CVD) risk assessment and management was published in 2023, including new risk treatment thresholds. Objective: This article summarises the published peer-reviewed global evidence that informed guideline recommendations on risk treatment thresholds for initiating blood pressure- and lipid-lowering therapy for CVD primary prevention. Discussion: Evidence from 13 meta-analyses, randomised controlled trials and modelling studies involving more than 515,700 patients showed that preventive pharmacotherapy reduced the number of CVD events at all risk levels. Findings informed the new risk treatment thresholds outlined in the 2023 Australian CVD risk assessment and management guideline, which recommends blood pressure- and lipid-lowering pharmacotherapy for people at high five-year risk (=10% based on the new risk calculator) and consideration of therapy for those at intermediate risk (5% to <10%) and generally does not recommend preventive pharmacotherapy for those at low risk (<5%). [ABSTRACT FROM AUTHOR]

The outdated cardiovascular disease risk calculator has been reported to overestimate cardiovascular disease risk for a contemporary Australian population, and does not include relevant variables, such as socioeconomic disadvantage, which has been shown to increase the incidence of both heart attack and stroke. The 2023 Australian Guideline for Assessing and Managing Cardiovascular Disease Risk marks a major milestone as the first update to Australia's cardiovascular disease prevention guideline in over a decade. The new guideline may help to refine and recategorise risk estimates, hence improving the discriminatory and predictive value of the new calculator. The new Australian Cardiovascular Disease Risk Calculator expresses risk scores as a percentage estimate of a person's probability of dying or being hospitalised due to cardiovascular disease within the next 5 years. The new calculator expresses risk scores as low (less than 5%), intermediate (5% to less than 10%), or high (10% or higher) risk over 5 years. Reclassification factors built into the new calculator are designed to help clinicians individualise risk estimates. These factors include ethnicity (e.g. First Nations status), family history of premature cardiovascular disease, severe mental illness, kidney disease and coronary artery calcium score. The new calculator also uses optional diabetes-specific variables (supporting a more granular cardiovascular disease risk assessment of people with type 2 diabetes). People who meet the clinically determined high-risk criteria (chronic kidney disease, familial hypercholesterolaemia) should not progress through the Australian Cardiovascular Disease risk calculator, but move straight to management. For a person with a cardiovascular disease risk score recorded from the outdated calculator, clinicians may want to reassess their risk using the new calculator the next time the person attends. [ABSTRACT FROM AUTHOR]

To explore the effect of SMS nudge messages amongst people with varying health literacy on their intention to get a Heart Health Check. A 3 (Initial SMS: scarcity, regret, or control nudge) x 2 (Reminder SMS: social norm or control nudge) factorial design was used in a hypothetical online experiment. 705 participants eligible for Heart Health Checks were recruited. Outcomes included intention to attend a Heart Health Check and psychological responses. In the control condition, people with lower health literacy had lower behavioural intentions compared to those with higher health literacy (p =.011). Scarcity and regret nudges closed this gap, resulting in similar intention levels for lower and higher health literacy. There was no interactive effect of the reminder nudge and health literacy (p =.724). Scarcity and regret nudge messages closed the health literacy gap in behavioural intentions compared to a control message, while a reminder nudge had limited additional benefit. Health literacy should be considered in behavioural intervention evaluations to ensure health equity is addressed. Results informed a national screening program using a universal precautions approach, where messages with higher engagement for lower health literacy groups were used in clinical practice. • People with lower health literacy are less likely to access health screening. • Nudges could be a cost-effective way to encourage the uptake of Heart Health Checks. • Type of nudge may interact with health literacy to change intention and behaviour. • Health interventions should consider health literacy to reduce health disparities. [ABSTRACT FROM AUTHOR]

Background: A new Australian guideline for cardiovascular disease (CVD) risk assessment and management was published in 2023, including new risk treatment thresholds., Objective: This article summarises the published peer-reviewed global evidence that informed guideline recommendations on risk treatment thresholds for initiating blood pressure- and lipid-lowering therapy for CVD primary prevention., Discussion: Evidence from 13 meta-analyses, randomised controlled trials and modelling studies involving more than 515,700 patients showed that preventive pharmacotherapy reduced the number of CVD events at all risk levels. Findings informed the new risk treatment thresholds outlined in the 2023 Australian CVD risk assessment and management guideline, which recommends blood pressure- and lipid-lowering pharmacotherapy for people at high five-year risk (≥10% based on the new risk calculator) and consideration of therapy for those at intermediate risk (5% to <10%) and generally does not recommend preventive pharmacotherapy for those at low risk (<5%).