Validation of Risk Perception Cut-Offs in Italian Brief PRHDS (PRHDS-BI): Implications for Primary Cardiovascular Prevention

Introduction: Effective cardiovascular (CV) prevention requires accurate risk estimation and patient engagement, which depends on perceived risk. The Perception of Risk of Heart Disease Scale (PRHDS) is a validated tool, yet clinical thresholds for its brief Italian version are lacking. Aim: To provide further validation of the Brief Italian version of the PRHDS (PRHDS-BI) in a new cohort, examining convergent and divergent validity, and to establish clinical thresholds and a discrepancy index comparing perceived risk with objective estimates. Methods: 285 adults (40-69 years) were involved in this multicentre cross-sectional study (NCT06190743). Participants were without a history of CV disease and completed the PRHDS-BI and the Patient Health Questionnaire-4 (PHQ-4). CV real risk was estimated using the Systematic Coronary Risk Evaluation 2 (SCORE2). Confirmatory Factor Analysis (CFA), correlation analyses, and cut-off definitions were used to validate the scale and analyze risk discrepancies. Results: The PRHDS-BI showed good internal consistency and strong convergent validity. Clinical thresholds were defined by percentiles: scores 6-12 (low/moderate), 13-17 (high), and 18-24 (very high). A significant mismatch emerged: 63.5% of participants at low/moderate actual risk overestimated their risk, while 80% at very high actual risk underestimated it. This perception-reality gap was statistically confirmed. Conclusions: The PRHDS-BI is a valid tool for assessing CV risk perception. Establishing thresholds allows for tailored risk communication and patient-centered interventions, particularly by nursing professionals in primary prevention settings.