Originally published here: Digital heart health tool helps young women face hidden cardiac risks

When Holly Gooding became an adolescent doctor, hoping to inspire young people to take care of their health earlier, one of her first priorities was helping young women recognize their risk of heart disease. “They don’t really have it on their radar at all,” she says. “They have many pressing issues on their minds. Heart disease is definitely not one that they ever raise with me.”   

Gooding, associate professor of pediatrics at the Emory School of Medicine, knows that cardiovascular disease is the leading cause of death for women, particularly for pregnant women. But adolescents are usually unaware of the risks. Gooding recognizes that identifying the risks earlier and educating young patients can create a healthier lifestyle when it’s time for them to start a family. 

“Heading into a pregnancy with cardiovascular risk factors increases the likelihood of adverse pregnancy outcomes,” she says. “That could be loss of the pregnancy. It could be gestational diabetes and hypertension. It can even be maternal death from hemorrhage or pre-eclampsia. Heading into a pregnancy as healthy as possible from a cardiovascular perspective is important to prevent those outcomes.” 

To meet that challenge, Gooding and her colleagues adapted an existing online program that lets adults evaluate their own heart disease risk by answering online questions without having to visit a doctor. The team worked with students from Georgia Tech’s App Hatchery, a mobile app consulting and development service, to repurpose it for adolescents and young women, adding lots of colorful, easy-to-follow visuals. Older questions and language had to be tailored for a younger audience. They named it HerHeart. Results of their research were published in Journal of Pediatric & Adolescent Gynecology.   

“We had students from Georgia Tech who were skilled in the development of web-based tools. They talked to teenagers, showing them prototypes of the tool and got their feedback on what would be represented visually as well as categories of activities and foods,” Gooding says. “We incorporated sports that were more popular among girls, like cheerleading and volleyball. It was teens themselves who suggested that we use emojis for the rating scales when they were rating whether they did something often or not.”

Testing HerHeart on teens and young women 

To see whether the tool would work in practice, Gooding’s team recruited 60 women ages 13 to 21 at two Atlanta clinics mostly serving low-income populations. The women were asked how they perceived their 10-year cardio risk on a one-to-10 scale, as well as their lifetime risk and there opinion on heart attack severeity. Subjects who stuck with the test over its three-month run increased their awareness of both risks, but not equally. 

“For both questions, they perceived their risk as very low, but it went from one to two out of ten on the 10-year risk," says Gooding. "And from two to three out of ten on the lifetime risk. They overestimated their 10-year risk and grossly underestimated their lifetime risk. For people this young, their ten-year risk is exceptionally low, less than 1% of having a heart attack or stroke, even if their behaviors are not that healthy. But their lifetime risk is actually closer to 50%. So we have some work to do in terms of how the tool is presenting that risk to them.” 

More optimistically, the relatively small number of women who stayed with the test for three months engaged in more heart-healthy activity by the end of the trial. 

“We did see a little bit of increase in their physical activity,” Gooding says. “And some decrease in processed meat consumption like hot dogs and bacon, plus a slight increase in their serving of vegetables, which is very encouraging. It’s hard to get teenagers to eat their vegetables.” 

Gooding is heartened (you might say) by what she learned even in her small pilot test but knows it’s a challenge to persuade a youthful population to change its health behavior. She hopes to partner with large healthcare systems to develop a more robust assessment tool that can help her develop incentives to keep more young women in the program to the end. 

“I do wonder, in today's social media day and age, whether there may be other avenues to reach out to women,” Gooding says. “Having HerHeart on various social media channels could be more beneficial. Young people, according to health psychologists, have a difficult time projecting into the future because they’re living in the moment. Trying to figure out how to communicate risk to a population that is wired to take a lot of risks, and communicate risk that is far off in the future is something we are still grappling with.” 

Learn more about this research, and view the HerHeart survey.