The impact and perception of England’s web-based heart age test of cardiovascular disease risk: A mixed-methods study

Background: It is well documented that individuals struggle to understand cardiovascular disease percentage risk scores which led to the development of heart age as a means of communicating risk. Developed for clinical use, its application in raising public awareness of heart health as part of a self-directed digital test has not been considered before.
Objectives: To understand who accesses England’s heart age test and its effect on user perception, knowledge and understanding of CVD risk, future behaviour intentions and potential engagement with primary care services.
Methods: There were three sources of data: 1. Routinely gathered data on all those accessing the heart age test (Feb 2015-Jun 2020); 2. Online survey, distributed January-March 2021; 3. Interviews with a sub-sample of survey respondents (February-March 2021). Data were used to describe the test user population, explore knowledge and understanding of CVD risk, confidence in interpreting CVD risk and control of CVD risk, and the effect on future behaviour intentions and potential engagement with primary care. Interviews were analysed using reflexive thematic analysis.
Results: Between Feb 2015 and Jun 2020, the heart age test was completed almost 5 million times, with more completions by males (54.8%), those aged 50-59 years (27.2%), from a White ethnic background (81%), and those living in the least deprived 20% of areas (14.4%). The study concluded with 819 survey responses and 33 semi-structured interviews. Participants suggested they understood the meaning of a higher estimated heart age and self-reported at least some improvements to understanding and confidence in understanding and control of CVD risk. Negative emotional responses were provoked among users when estimated heart age did not equate to their prior risk perceptions. The limited information needed to complete it or the production of a result when physiological risk factor information was missing (i.e., blood pressure, cholesterol) led some users to question the credibility of the test. Yet, most suggested they would or had already recommended the test to others, would use it again in the future, would be more likely to take up the offer of a NHS Health Check, and self-reported that they had made or intended to make changes to their health behaviour or felt encouraged to continue to make changes to their health behaviour.
Conclusions: England’s web-based heart age test has engaged large numbers of people on their heart health. Improvements to England’s heart age test, noted in this paper, may enhance user satisfaction and prevent confusion. Future work to understand the longer-term benefit of the test on behavioural outcomes is warranted.