Cardiovascular risk communication strategies in primary prevention. A systematic review with narrative synthesis.

No meta-analysis was possible because study designs and outcomes varied too much, so the review relies on narrative summaries that can be interpreted subjectively. Many included studies used hypothetical risk scenarios, so emotional reactions may not match a real clinic conversation. Some samples were low-risk, health-interested, or mostly male, so results may not apply to patients with higher or more diverse risk profiles. Several strategies were delivered as part of complex care, such as scan feedback plus verbal risk categories, telephone follow-up, or agreed behaviour-change plans, so the effect of any single format cannot be separated. Qualitative studies were mostly medium or low quality, with weak analysis and unclear findings in some reports. All included studies were published in English and conducted mainly in high-income western countries. This limits cultural transferability. Cardiovascular imaging may be expensive, time-consuming, or unavailable in some settings, and normal scans can provide false reassurance.

The work was funded by a British Heart Foundation Research Training Fellowship for Nurses and Healthcare Professionals and by British Heart Foundation support for another author. The authors declared no conflicts of interest.

Do not conclude that heart age or imaging should be used routinely to motivate patients. Heart age was less credible and may increase anxiety, and imaging feedback was studied alongside scan results, verbal categories, telephone follow-up or other care, so the effect cannot be assigned to the format alone.