E-CHARM Heart Age Trial in Primary Care: Design and Baseline Findings

TL;DR

This study tests a Heart Age risk-education tool in older adults with hypertension to improve cardiovascular risk awareness and lifestyle behavior in primary care.

Contribution

A novel Heart Age report derived from routine exams and delivered with brief counseling is tested in a community health system.

Findings

Baseline cardiovascular risk awareness was only weakly correlated with Heart Age gap.

Medication adherence and lifestyle indicators were moderate among participants.

The Heart Age report was feasible to implement without additional costs or tests.

Abstract

Cardiovascular risk awareness among older adults often fails to align with physiological risk, limiting prevention. “Heart Age” Re-frames risk as an intuitive biological age; however, evidence from community primary care, particularly in resource-limited settings, remains scarce. We designed an individually randomized trial in a community health system to test a structured Heart Age risk-education report generated from ASCVD components fully extracted from Chinese government-funded annual physical exams and delivered with a brief physician explanation and tailored lifestyle guidance during routine follow-up, with no extra tests or visits. Older adults with hypertension were allocated to usual care plus the Heart Age report (intervention) or usual care (control). Baseline measures included demographics, a 10-item cardiovascular risk awareness score (0–10), lifestyle indicators (e.g., fruit-intake days/week), medication adherence by the 4-item Morisky scale (MMAS-4; 0–4, higher=better), and routine clinical data. We enrolled 378 participants (174 intervention; 204 control), mean age 66.8±12.0 years. The awareness score averaged 7.16/10; fruit-intake frequency was median 5 days/week (IQR 3–7); medication adherence was mean 2.71/4, median 3 (IQR 2–4). Among intervention participants with complete Heart Age data (n = 174), the Heart Age gap (Heart Age − chronological age) was 8.2±11.7 years. Risk awareness showed near-zero correlation with the Heart Age gap (r≈0.05, 95% CI − 0.10 to 0.20); age-sex adjustment gave similar results. Leveraging routinely collected exams to produce an ASCVD-based Heart Age report with brief lifestyle counseling appears feasible at no added cost; the baseline misalignment highlights room, and opportunity, for improved risk communication. Endline effectiveness evaluation is ongoing.