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A Tool to Identify Early Warning Signs of Heart Disease

Taking an analog 9-question prodromal symptom screening scale and turning it into a user-friendly pathway that could be used at home or within a clinician’s office.


Did you know that fatigue, shortness of breath, and aches and pains in unexpected places can be early warning signs of developing heart disease? A study conducted and led by Sheila O’Keefe-McCarthy, (PhD, RN) out of Brock University has lead to the discovery of these and other transitory early warning signs, that may not be recognized as cardiac-related — especially in women.

Our challenge was to take the original analog 9-question prodromal symptom screening scale and turn it into a user-friendly pathway that could be used at home or within a clinician’s office. The goal was to give people the ability to be more proactive in caring for their heart.

We were also tasked with translating the study findings into an educational piece for people who may be at risk for developing heart disease, and for clinicians to share with their patients.


We worked with the team at Brock University to create user personas, which helped us determine the best format for the Prodromal Symptoms Screening Scale and the educational pieces.

The Prodromal Symptoms Screening Scale assumed a digital format, a decision based upon the personas informed by the team at Brock. First we worked closely with Dr. O’Keefe-McCarthy to iterate her original 9-question pathway into a comprehensive algorithm that consists of 2 sets of questions and multiple outcomes.

The educational piece took on a few different forms to reach a broad audience. The Prodromal Symptom Screening Scale itself is housed on a site that provides concise information about the study conducted. We also created an infographic in a variety of formats — a poster that can hang in a physician’s office, along with a postcard-sized take-away that clinicians can give to their at-risk patients.

Last, we produced a short educational video about the research conducted by the team at Brock, featuring patients who took part in the study along with the key researchers.


The Prodromal Symptom Screening Scale is now available for public use, and will be undergoing trials over the next few years.

Pivot listened and understood the needs of all our stakeholders (clinicians & decision makers). They were responsive, efficient and timely which ensured our project was completed on time and resulted in a website (online clinical tool) that is being used nationally!”

Project Lead