Risk communication strategies in patients with cardiovascular disease, atrial fibrillation or heart failure. A systematic review with narrative synthesis

Background Individual risk communication is recommended by guidelines on cardiovascular disease (CVD) prevention. However, optimal means of communicating risk to patients in routine care remain unclear. This systematic review investigates strategies for health professionals to communicate individually determined risk for major cardiovascular events in patients with history of CVD, atrial fibrillation or heart failure, during personal encounters. Methods A systematic search, complemented by manual and citation searching, was conducted in MEDLINE and Web of Science for articles published between 01/01/2000 and 15/09/2025. The prospectively registered review (PROSPERO CRD42023471655) followed the PRISMA guidelines. Abstract, full-text screening, and data extraction were conducted by two independent reviewers. The narrative synthesis was separated into direct evidence from secondary prevention exclusive studies, and indirect evidence from mixed prevention setting studies (primary and secondary prevention). Results Of 10,908 records, 336 reports were assessed for eligibility. Eighteen reports from five secondary prevention and eight mixed prevention setting studies were identified. Study characteristics were very heterogeneous with regard to risk communication strategies, risk determination methods, patient populations, sample sizes, and investigated outcomes. In secondary prevention, risk communication strategies included the graphical depiction of individual CVD risk as 100-person pictogram or bar graph, and non-standardized or standardized oral communication. Additional strategies identified in mixed prevention setting studies included graphical illustration of time-to-event estimates, and pie charts. Most commonly, risk communication was embedded in interventions with shared decision-making or multicomponent approaches. In secondary prevention studies, trends toward improvements in clinical outcomes (blood pressure, healthy lifestyle, functional outcomes after stroke) and risk perception were observed for interventions comprising the calculation and communication of CVD risk. In mixed prevention setting studies, improvements in clinical (blood pressure, lipid control, and CVD risk) and several patient-centred outcomes including risk perception were observed. Conclusion Only few studies reported on risk communication strategies in secondary prevention. The investigated risk communication strategies and findings were heterogeneous throughout the secondary and mixed prevention settings. The findings preclude the identification of a clearly superior risk communication strategy. Hence, methodologically sound studies are needed to facilitate the systematic development of evidence-based risk communication strategies for application in clinical routine.