reviewed by Elena Cavarretta

Introduction

Shared decision-making (SDM) for cardiovascular prevention is not just a valuable approach, it is essential [1, 2]. Cardiovascular diseases (CVD) are the leading cause of death globally, and many of the risk factors, such as high blood pressure, high cholesterol, smoking, unhealthy eating, alcohol consumption, sleep deprivation, and sedentary lifestyles, are modifiable. However, preventing CVD is not just about prescribing medications or recommending lifestyle changes; it is about empowering patients to take an active role in their health. This leads to better adherence to treatment plans, improved outcomes, and greater patient satisfaction [3, 4].
The following step-by-step guide outlines how healthcare providers can effectively engage patients in SDM for cardiovascular prevention.

Step 1: Build a Trusting Relationship

A strong patient-provider relationship is the foundation of shared decision-making [5, 6]. Patients are more likely to engage in the process if they feel respected, heard, and supported.

• Communicate openly and empathetically, using active listening to understand the patient’s concerns, fears, and expectations. Despite time constraints, minimising distractions (e.g., phone calls) and focusing fully on the patient fosters trust even in brief interactions. Prioritising undivided attention demonstrates respect and supports a more meaningful connection.
• Establish rapport. Get to know the patient beyond their medical history, including their lifestyle, cultural background, and personal goals.
• Be transparent. Explain that your role is to guide and support them in making informed decisions, rather than making choices on their behalf.

Step 2: Educate Patients About Cardiovascular Risk

Patients need to understand their cardiovascular risk factors and the importance of prevention before they can participate in decision-making [7].

• Use clear, non-technical language, avoiding medical jargon. Explain terms like cholesterol, blood pressure, and atherosclerosis in simple, relatable terms. Additionally, help patients understand basic body functions—teaching them to recognise subtle symptom changes, differentiate between medication effects and disease progression, and identify when to seek medical attention. This empowers them to communicate more effectively with healthcare providers and take an active role in their care.
• Provide visual aids. Use charts, diagrams, and online risk calculators to help patients visualize their risk.
• Discuss modifiable vs. non-modifiable risk factors. Explain which factors they can control (e.g., diet, alcohol consumption, smoking, exercise) and which they cannot (e.g., age, family history).

Step 3: Present Evidence-Based Options

Offer patients a range of evidence-based options for cardiovascular prevention, tailored to their individual risk profile [8].

• Discuss lifestyle changes. Emphasize the importance of a heart-healthy diet, alcohol consumption, regular physical activity, smoking cessation, and stress management.
• Explain medication options. If applicable, discuss the benefits, risks, and side effects of medications like statins, antihypertensives, or aspirin.
• Highlight preventive procedures. For high-risk patients, explain interventions such as blood pressure monitoring or cardiac screenings.

Step 4: Explore Patient Values and Preferences

Understanding what matters most to the patient is key to making decisions that align with their goals.

• Ask open-ended questions. For example, “What are your thoughts about taking medication?” or “How do you feel about making lifestyle changes?”
• Respect cultural and personal beliefs. Be mindful of how cultural, religious, or personal values may influence their decisions.
• Discuss trade-offs. Help patients weigh the pros and cons of each option based on their priorities (e.g., quality of life vs. potential side effects).

SDM is not just about presenting facts, it is about guiding patients through their priorities and helping them find a solution that truly aligns with their life goals. Perhaps they’re worried about the cost of medications, unsure how to prepare healthy meals, or frustrated by past failed attempts to quit smoking [1, 9]. By actively listening, you are doing more than just gathering information, you are demonstrating that their concerns, experiences, and choices matter.

Step 5: Use Decision Aids

Decision aids are tools designed to help patients understand their options and make informed choices [10].

• Provide written or digital materials, such as brochures, videos, or online resources, to reinforce the information discussed during the visit. Encourage patients to explore reputable patient associations and support networks, as these can also serve as valuable sources of reliable information and peer support.
• Use interactive tools. Online risk calculators or apps can help patients visualize the impact of different choices on their cardiovascular health.
• Encourage questions and help patients feel comfortable asking for clarification. Suggest they prepare for visits by writing down key concerns or questions in advance, ensuring they make the most of their time with you.

Step 6: Collaborate on a Personalised Plan

Work with the patient to create a prevention plan that reflects their preferences and is realistic for their lifestyle [11].

• Set achievable goals. Break down larger goals into smaller, manageable steps (e.g., “Start by walking 10 minutes a day”).
• Address barriers. Identify potential obstacles (e.g., cost of medications, time constraints) and brainstorm solutions together.
• Create a visually clear action plan using graphics/icons to emphasize key steps. Include an interactive tracker (e.g., checklist or calendar) to help patients monitor progress and celebrate milestones. Provide a copy for their reference.

Write it down and give them a copy. This is not just a plan — it is a promise. You are saying, “I’m here to support you, and we’re in this together.” By personalising the plan, patients feel empowered and accountable rather than pressured or forced into a decision [12].

Step 7: Follow Up and Adjust as Needed

Shared decision-making is an ongoing process, not a one-time event.

• Schedule regular check-ins. Monitor progress, address concerns, and adjust the plan as needed.
• Celebrate every success, no matter how small. Consider adding playful motivation tools—like achievement badges, a points system, or progress visuals—to help patients see their growth and stay engaged in their care journey.
• Reassess goals. As the patient’s health or circumstances change, revisit their preferences and update the prevention plan accordingly.

This is not just encouragement—it is motivation. When patients feel successful, they’re more likely to keep going [1, 4].

Tips for Success

• Be patient. Some patients may need time to process information and make decisions.
• Stay non-judgmental. Avoid making patients feel guilty or pressured about their choices.
• With the patient’s consent, involve family members or caregivers in discussions – particularly when implementing diet or lifestyle changes that affect shared living situations. Their inclusion can provide crucial support and help create a sustainable care environment.

Conclusion

Engaging patients in shared decision-making for cardiovascular prevention is a powerful way to improve health outcomes and patient satisfaction. By building trust, providing clear information, and respecting patients’ values, healthcare providers can empower individuals to take control of their heart health. Remember, the goal is not to dictate what patients should do, but to guide them in making informed decisions that align with their unique needs and goals.

Shared decision-making is not just a tool—it is a mindset. It is about seeing patients as partners, not problems to solve. It is about meeting them where they are and walking with them toward better health. And sometimes, it’s about celebrating the small victories, like a 10-minute walk or one less cigarette, because those are the steps that lead to lasting change.

It recognises that patients are experts in their own lives and that the best decisions are made when physicians and patients work together as partners. By embracing SDM, we can help patients not only live longer but also live better, with a greater sense of control and confidence in their health.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.