Missed Opportunities in Communicating CVD Risks to Psoriasis Patients

A study in Health Expectations suggests that health care practitioners who treat psoriasis patients often miss important opportunities to communicate the cardiovascular risks those patients are likely to face. The study authors point out that health care professionals need to help patients with psoriasis understand the personal relevance of lifestyle behavior choices, which often lead to both worsening psoriasis and substantial comorbidity with cardiovascular disease (CVD).

Patients with psoriasis often struggle with the disease long-term, and they often have high levels of chronic physical and psychosocial disability. Earlier studies have shown a significant relationship between severe psoriasis and CVD that may go beyond lifestyle factors, but that relationship is not yet fully understood, despite a wealth of clinical studies that have attempted to define it.

Certainly, unhealthy lifestyle behaviors such as excess alcohol consumption, smoking, inactivity, and higher body mass index are all known to be more common in people with psoriasis than the general population. Those behaviors have the double-whammy effect of increasing other risk behaviors.

What can practitioners do? The study authors suggest that, “The ways in which individuals perceive risk are influenced by their prior awareness and understanding of the risk as well as how it is presented to them. Communicating CVD risk is particularly complex because risk calculation/assessment involves amalgamating information about a range of physiological and lifestyle factors to predict patients’ future risk, often in the absence of current symptoms. Health professionals may use population risk values which lack personal relevance to patients, whereas personalized risk information may be required to increase risk understanding.”

Even then, it is unclear how much of an impact this communication about CVD risk actually has on the likelihood of patients engaging in risky behaviors.

The mixed-methods study of psoriasis patients undergoing CVD risk assessment aimed to determine the proportions of CVD risk factors among patients with psoriasis at risk assessment, and further, to examine patient and practitioner experiences of risk communication through a qualitative survey. A high proportion of patients had risk factor levels apparent at risk assessment above NICE recommendations, including very high waist circumference (52%), obesity (35%), raised blood pressure (29%), smoking (18%) and excess alcohol consumption (18%).

There was little evidence of personalized discussion about CVD risk and behavior change support in consultations.

Post-intervention interviews with both patients and practitioners revealed a troubling trend: Patients wanted to discuss CVD risk and risk reduction with their trusted health care professional. But practitioners reported a lack of training in behavior change, and were thus less likely to engage patients with discussions about risk reduction.

Consultations, which were recorded for review, were often characterized by practitioners ignoring or disregarding opportunities for consultations, even when asked direct questions by patients.

Patients often assumed that busy practitioners would consider their concerns trivial, or were too anxious to raise health concerns. Practitioners reported that their main focus in these consultations was on gathering information from patients and informing/educating them about healthy lifestyle behaviors with reference to government recommendations or advice.

“This suggests that they were less focused on patient-led discussion in which they could use cues in consultations to talk about patients’ own concerns and explains the focus on information recording and lack of detailed discussion apparent in the consultations,” the study authors note.

The study authors conclude that a shift in the focus of screening consultations is needed to encompass effective discussions and interventions to address CVD risk factors, including behavioral factors.