Designing Cardiovascular Risk Communication

March 7, 2016

Dylan Collins & Stefania Marcoli discuss how they are re-designing cardiovascular risk communication strategies for clinical practice, intersecting evidence-based medicine, human centred design, and visual thinking.

Project ideation work at frog’s studio in Milan (DC)

Cardiovascular Disease is a Global Epidemic

Cardiovascular disease (CVD), a collection of related conditions that include stroke and heart attack, is the leading cause of death and disability worldwide. More people die from clogged arteries than HIV/AIDS, Cancer, Chronic Respiratory Disease, Tuberculosis, or Trauma.

What is Cardiovascular Risk?

Cardiovascular risk is the risk of having a cardiovascular event — such as a heart attack or stroke — in a given time period, usually represented as a percentage. For example, a 10% risk score would translate to a 10% chance of having a CVD event in the next ten years. To caluclate CVD risk, most risk calculators use age, gender, systolic blood pressure, cholesterol, whether you smoke or not, and whether or not you have diabetes.

Some of these risk factors are not modifiable, most notably: age. The older you get the more likely you are to develop CVD. Prevention efforts therefore focus on the things we can change, the modifiable risk factors. These risk factors, and the risk they give you, can be modifed through behaviour change or medication: we can lower cholesterol, stop smoking, and reduce our blood pressure.

Early prototype of the consultation journey we will use in the design studio with doctors (DC & SM)

Traditional approaches for preventing CVD are vertical in nature; that is, treating each risk factor in isolation. This approach fails to account for all of the other possible dimensions that may influence a person’s risk of developing CVD. Yes — a person with high blood pressure may be more likely to develop CVD than someone with lower blood pressure — but in the context of their overall health, their age, their other CVD risk factors, they may actually be at overall low risk.

To account for these interactions, global cardiovascular risk assessment was developed.Global cardiovascular risk assessment is an integrated approach that considers several risk factors in the context of each other, to calculate a person’s overall risk of developing cardiovascular disease in given period of time. With this approach it’s possible, for example, to treat cholesterol in a patient with high overall risk but ‘normal’ cholesterol.

Risk Communication in Clinical Practice

Despite the continued improvements in methods to calculate CVD risk,communicating risk scores to patients is challenging for clinicians. In an in-depth qualitative study done by researchers at the University of Oxford who were interested in how these risk scores were used in practice, the authors found considerable confusion amongst healthcare professionals about which scores to use, how to communicate the scores, and their potential impact on patient health.

“ There was substantial variation in opinion about whether scores could legitimately be used to illustrate to patients the change in risk as a result of treatment. The overall impression was of considerable confusion.”
– Liew et al. (2013)

Furthermore, risk estimates are not intuitive to understand, and therefore often not well understood by patients. This is of course, a problem, because without understanding your risk, you’re less likely to make behaviour changes, adhere to treatments, and improve your health.

So, here we find ourselves. Risk scores are challenging for doctors to communicate, difficult for patients to understand, and important for improving health. We’re trying something new.

Putting the Patient at the Centre of Risk Communication

Together, Dylan Collins, a doctoral candidate the Centre for Evidence-Based Medicine and Stefania Marcoli, Principal designer at frog, are working to re-imagine the ways in which doctors can communicate cardiovascular risk to patients using human centred design (HCD).

Prototype of persona development for design studio workshop (DC &SM)

HCD is about translating human needs and desires into experiences that are fulfilling. To do this, we place the human experience at the core, engaging people as participants through the whole process. HCD provides tools to facilitate conversations and shape solutions, from visualizing ideas together to making them real, prototyping and testing them in an iterative way. Visual thinking, an integral component of HCD, is about facilitating thought through visual processing by making ideas tangible with visual elements and compositions.

We believe HCD and visual thinking are ideal methods to generate new, innovative approaches for risk communication. Over the next few months, we will be designing, ideating, and prototyping an open-source tool that doctors and patient can use together to communicate cardiovascular risk and visualise the impact of modifying risk factors. At the end of the project, this tool will published and freely available. We hope doctors will try using it in their practice, adapt it to their needs, and share their experience with us.

The Path Forward

Over the next three months, we will be documenting our journey and writing about our experience. We are now working to refine the models and tools that we will use with doctors to ideate new solutions. We will also share some of these tools with the public, and provide instructions for their use. Stay tuned for updates, tweet us your questions or comments, or to tell us about your own projects that intersect human centred design, visual thinking and medicine.


Dylan Collins is a Rhodes Scholar, Healthcare Designer, and PhD Candidate at the Centre for Evidence-based Medicine at the University of Oxford.

Dylan Collins (@DylanRJCollins) | Twitter
DPhil Candidate, Rhodes Schola @oxprimarycare  @CebmOxford @uniofoxford | Tweeter of



Stefania Marcoli is a Principal Designer specialised in healthcare, at frog.

Stefania Marcoli (@stefina) | Twitter
People stories. Draw the future, make it today. Principal Designer @frogdesign




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