Patient and Physician Perspectives on Cardiovascular Risk: A Multicenter Survey of Communication Gaps Among Hospitalized Patients in Spain

Abstract

Background: Effective risk communication is essential in managing cardiovascular disease, the leading cause of global mortality. Clear communication between patients and physicians supports informed decision-making, yet comprehension gaps persist. We aimed to assess the quality of risk communication during hospital admissions for cardiovascular events, from patient and physician perspectives, and identify discrepancies in risk perception and associated factors.

Methods: The HARIPA study (Heart Risk Perception and Communication Inpatient) by the Spanish Society of Cardiology was a multicenter, cross-sectional analysis conducted in 28 hospitals across Spain from October 2022 to March 2023. It included consecutive cardiology inpatients (urgent or scheduled), aged ≥18 years, who could complete structured questionnaires. Participating physicians also completed parallel questionnaires. These assessed admission diagnosis, perceptions of future cardiovascular risk, and communication about potential procedural complications. Agreement between responses was evaluated using kappa indices (weighted for ordinal variables), and multivariable logistic regression was used to examine the impact of demographic and clinical factors (odds ratios with 95% CIs).

Results: We included 943 patients (mean age, 68.2 years; 29.4% women). The most frequent reason for admission was ischemic heart disease (41.3%). Responses resulted in a substantial agreement, with a kappa index of 0.72. Concordance between patients and physicians regarding future cardiovascular risk was low (weighted kappa: 0.29), with patients often underestimating their risk. And for assessment about procedural potential complications was moderate (kappa: 0.34). Although 76.9% of patients reported feeling adequately informed about procedural risks, 69.3% of those who experienced complications (n=208) stated they had not been warned about them.

Conclusions: This study reveals significant gaps in risk communication in cardiovascular care, particularly regarding future risks and complications. As well-informed patients are more likely to adhere to preventive therapies, tailoring communication strategies to individual patient characteristics could improve understanding and align perceptions with clinical realities, enhancing health outcomes.

Keywords: cardiovascular; communication; perception; risk factors.