# Interactive Digital Visualization Counseling for Lifestyle Change in Patients at Risk of Cardiovascular Diseases: Randomized Controlled Trial

## TL;DR

This study tested if digital tools for visualizing heart disease risk and glucose levels help patients adopt healthier lifestyles and feel more involved in their care.

## Contribution

The study introduces a feasibility trial of combining CVD risk visualization and continuous glucose monitoring for lifestyle change in primary care.

## Key findings

- Healthy lifestyle and perceived person-centered care scores improved across all groups, but no significant differences were found between groups.
- Risk visualization may increase CVD awareness and patient involvement, but larger studies are needed to confirm these effects.
- Baseline CVD risk scores varied slightly between groups, but changes over 6 months were not statistically significant.

## Abstract

Cardiovascular disease (CVD) remains the leading cause of death. Primary prevention relies heavily on health risk assessments and lifestyle changes, which can reduce long-term risk and mortality. Digital health offers an accessible and cost-effective approach to support prevention, enabling data sharing and visualization of key indicators such as blood pressure and glucose fluctuations. These visual insights may help patients better understand the effects of lifestyle changes and enhance communication with health care providers.

This research aims to evaluate whether the use of CVD risk visualization (Petal-X) and continuous glucose monitoring (CGM), alone or in combination, is associated with lifestyle changes and the perception of person-centered care (PCC) among patients at increased risk of CVD.

We conducted a 4-arm, single-blind, 2×2 factorial randomized controlled feasibility trial in primary care. A total of 119 participants were enrolled, of whom 101 completed the 6-month follow-up. Participants were randomized to 1 of 4 arms: (1) Petal-X CVD risk visualization+CGM; (2) CGM only; (3) Petal-X only; or (4) standard care with routine lifestyle counseling and no digital tools. CGM was used for 10 days in the CGM arms. Since this was a feasibility trial, no formal sample size calculation was performed. Primary outcomes are healthy lifestyle (Health Lifestyle and Personal Control Questionnaire [HLPCQ]) and perception of PCC (Person-Centered Practice Inventory—Service User [PCPI–SU]), and secondary outcomes (Systematic Coronary Risk Evaluation 2 [SCORE2], anthropometrics, and biological age) were assessed at baseline and 6 months. Descriptive statistics and Kruskal-Wallis tests (K independent samples) were used for analyses.

At baseline, mean SCORE2 values ranged from 3.84 (SD 2.08) in intervention group 3 to 4.87 (SD 2.61) in intervention group 1, with the control group having a mean value of 4.53 (SD 3.63). Regarding the assessment of a healthy lifestyle, the domain of daily routine had the highest baseline scores across all groups (eg, mean 19.24, SD 5.87 in intervention group 1), and these scores improved by the final evaluation, although there were no statistically significant differences (P=.42) in changes between the groups. The perception of PCC was rated highest across all groups in the domain of shared decision-making, with no statistically significant differences (P=.26) between the groups. Results indicated improvements in healthy lifestyle habits, but the impact of interventions on perceived changes remained insignificant.

Healthy lifestyle and perceived PCC scores improved, although no statistically significant between-group differences were found. Risk visualization appears to be a key tool for increasing CVD awareness and strengthening patient involvement in care planning. Longer interventions with larger samples are needed to clarify these effects and optimize digital tools for lifestyle change.