Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study

Weng, Stephen and Kai, Joe and Tranter, Jennifer and Leonardi-Bee, Jo and Qureshi, Nadeem (2018) Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study. Atherosclerosis, 274 . pp. 54-60. ISSN 0021-9150

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Abstract

Background and Aims: Familial hypercholesterolaemia (FH) is a major cause of premature heart disease but remains unrecognised in most patients. This study investigated if a systematic primary care-based approach to identify and manage possible FH improves recommended best clinical practice.

Methods: Pre- and post-intervention study in six UK general practices (population 45,033) which invited patients with total cholesterol >7.5 mmol/L to be assessed for possible FH. Compliance with national guideline recommendations to identify and manage possible FH (repeat cholesterol; assess family history of heart disease; identify secondary causes and clinical features; reduce total & LDL-cholesterol; statin prescribing; lifestyle advice) was assessed by calculating the absolute difference in measures of care pre- and six months post-intervention.

Results: The intervention improved best clinical practice in 118 patients consenting to assessment (of 831 eligible patients): repeat cholesterol test (+75.4%, 95% CI 66.9-82.3); family history of heart disease assessed (+35.6%, 95% CI 27.0-44.2); diagnosis of secondary causes (+7.7%, 95% CI 4.1-13.9), examining clinical features (+6.0%, 95% CI 2.9-11.7). For 32 patients diagnosed with possible FH using Simon-Broome criteria, statin prescribing significantly improved (18.8%, 95% CI 8.9-35.3) with non-significant mean reductions in cholesterol post-intervention (total: -0.16 mmol/L, 95% CI -0.78-0.46; LDL: -0.12 mmol/L, 95% CI -0.81-0.57).

Conclusions: Within six months, this simple primary care intervention improved both identification and management of patients with possible FH, in line with national evidence-based guidelines. Replicating and sustaining this approach across the country could lead to substantial improvement in health outcomes for these individuals with very high cardiovascular risk.

Item Type: Article
RIS ID: https://nottingham-repository.worktribe.com/output/948572
Keywords: Primary health care; Familial hypercholesterolaemia; Family health; Medical genetics.
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Primary Care
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Epidemiology and Public Health
Identification Number: https://doi.org/10.1016/j.atherosclerosis.2018.04.037
Depositing User: McCambridge, Mrs April
Date Deposited: 01 May 2018 11:15
Last Modified: 04 May 2020 19:47
URI: http://eprints.nottingham.ac.uk/id/eprint/51490

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