Alcohol use as a modifiable risk factor in cardiology : prevalence, patient perspectives, and clinician views

<p dir="ltr">Background: Alcohol use and cardiovascular disease are major contributors to the global burden of disease and represent key public health challenges in Europe. However, despite increasing emphasis on the role of alcohol use as a modifiable cardiovascular risk factor, there has been little focus on addressing alcohol use in cardiology services. There is a need to understand patient- and clinician-related factors such as risk perceptions, acceptability, and perceived feasibility, to support the implementation of alcohol interventions.</p><p dir="ltr">Aims: The aim of this doctoral thesis was to understand factors affecting the implementation of alcohol interventions in cardiology services in Sweden, with a view to informing the development of effective implementation strategies.</p><p dir="ltr">Methods and results: Five studies were conducted, including cross-sectional surveys, qualitative interviews, and integrative mixed methods approaches.</p><ul><li>Study I found that the prevalence of hazardous alcohol use among cardiology patients at three hospitals in Sweden was approximately 8% (95% CI = 6.2-9.3), while about 1% (95% CI = 0.3-1.5) met the screening threshold for probable alcohol dependence, highlighting a need for screening and brief interventions (SBI) in cardiology services.</li><li>Study Il indicated that cardiology patients were exposed to mixed messages about the cardiovascular effects of moderate alcohol consumption, often through media reports. Exposure to mixed messages was associated with higher odds of reporting hazardous alcohol use (OR = 1.67, 95% CI = 1.02-2.74).</li><li>Studies III & IV identified a range of clinician-related barriers to alcohol interventions, including stigma, competing professional priorities, and low competence with SBI, along with opportunities for alcohol interventions in routine cardiology practice. Doctors and outpatient staff tended to view alcohol interventions as clinically feasible.</li><li>Study V examined patient perspectives and found that alcohol interventions were viewed as acceptable and relevant within cardiology.</li></ul><p dir="ltr">Conclusions: This doctoral project demonstrated a need for alcohol interventions in cardiology services and identified opportunities for implementation in routine practice. We found that cardiology staff view alcohol interventions as important, but successful implementation will require a range of barriers to be addressed - particularly stigma and a lack of knowledge among clinicians. Findings suggest a possible role for tailored nurse-led interventions in the outpatient setting. Promising strategies include competency-based training for clinicians and engaging key stakeholders, such as arrhythmia and heart failure specialists, during implementation.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Welfordsson P,</b> Danielsson AK, Björck C, Grzymala-Lubanski B, Hambraeus K, Löfman IH, Braunschweig F, Lidin M, Wallhed Finn S. Hazardous alcohol use: a cross-sectional study of cardiology patients in Sweden. J Public Health (Oxf). 2025 May 15:fdaf057. PMID: 40369959.<br><a href="https://doi.org/10.1093/pubmed/fdaf057">https://doi.org/10.1093/pubmed/fdaf057<br></a><br></p><p dir="ltr">II. <b>Welfordsson P,</b> Danielsson AK, Björck C, Grzymala-Lubanski B, Lidin M, Löfman IH, Wallhed Finn S. Mixed messages? Exposure to reports about alcohol's suggested cardiovascular effects and hazardous alcohol use: a cross-sectional study of patients in cardiology care. BMC Public Health. 2024 May 13;24(1):1302. PMID: 38741107.<br><a href="https://doi.org/10.1186/s12889-024-18783-5">https://doi.org/10.1186/s12889-024-18783-5<br></a><br></p><p dir="ltr">III. <b>Welfordsson P,</b> Danielsson AK, Björck C, Grzymala-Lubanski B, Hambraeus K, Lidin M, Haugen Löfman I, Scheffel Birath C, Nilsson O, Braunschweig F, Wallhed Finn S. Feasibility of alcohol interventions in cardiology: a qualitative study of clinician perspectives in Sweden. Eur J Cardiovasc Nurs. 2024 Sep 5;23(6):668-674. PMID: 38445448. <a href="https://doi.org/10.1093/eurjcn/zvae033">https://doi.org/10.1093/eurjcn/zvae033<br></a><br></p><p dir="ltr">IV. <b>Welfordsson P,</b> Danielsson AK, Björck C, Grzymala-Lubanski B, Hambraeus K, Haugen Löfman I, Nilsson O, Braunschweig F, Lidin M, Wallhed Finn S. Feasibility of alcohol interventions in cardiology: a mixed methods study of clinician perspectives in Sweden. Eur J Cardiovasc Nurs. 2025 Jun 12:zvaf109. PMID: 40505110.<br><a href="https://doi.org/10.1093/eurjcn/zvaf109">https://doi.org/10.1093/eurjcn/zvaf109<br></a><br></p><p dir="ltr">V. <b>Welfordsson P,</b> Danielsson AK, Björck C, Grzymala-Lubanski B, Hambraeus K, Löfman IH, Braunschweig F, Lidin M, Wallhed Finn S. Alcohol use as a modifiable risk factor in cardiology: A qualitative study of patient perspectives in Sweden. PLoS One. 2025 Aug 4;20(8):e0328990. PMID: 40758666; PMCID: PMC12321063. <a href="https://doi.org/10.1371/journal.pone.0328990" rel="noreferrer" target="_blank">https://doi.org/10.1371/journal.pone.0328990</a></p>