Brett, T and Chan, DC and Radford, J and Heal, C and Gill, G and Hespe, C and Vargas-Garcia, C and Condon, C and Sheil, B and Li, IW and Sullivan, DR and Vickery, AW and Pang, J and Arnold-Reed, DE and Watts, GF, Improving detection and management of familial hypercholesterolaemia in Australian general practice, Heart, 107, (15) pp. 1213-1219. ISSN 1355-6037 (2021) [Refereed Article]
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Objective: Familial hypercholesterolaemia (FH) is characterised by elevated low-density lipoprotein (LDL)-cholesterol and increased risk of cardiovascular disease. However, FH remains substantially underdiagnosed and undertreated. We employed a two-stage pragmatic approach to identify and manage patients with FH in primary healthcare.
Methods: Medical records for 232 139 patients who attended 15 general practices at least once in the previous 2 years across five Australian States were first screened for potential risk of FH using an electronic tool (TARB-Ex) and confirmed by general practitioner (GP) clinical assessment based on phenotypic Dutch Lipid Clinic Network Criteria (DLCNC) score. Follow-up GP consultation and management was provided for patients with phenotypic FH.
Results: A total of 1843 patients were identified by TARB-Ex as at potential risk of FH (DLCNC score ≥5). After GP medical record review, 900 of these patients (49%) were confirmed with DLCNC score ≥5 and classified as high-risk of FH. From 556 patients subsequently clinically assessed by GPs, 147 (26%) were diagnosed with phenotypic FH (DLCNC score >6). Follow-up GP consultation and management for 77 patients resulted in a significant reduction in LDL-cholesterol (-16%, p<0.01). A higher proportion of these patients attained the treatment target of 50% reduction in LDL-cholesterol (74% vs 62%, p<0.001) and absolute levels of LDL-cholesterol goals compared with baseline (26% vs 12%, p<0.05).
Conclusions: A pragmatic approach integrating electronic medical record tools and clinical GP follow-up consultation is a feasible method to identify and better manage patients with FH in the primary healthcare setting.
|Item Type:||Refereed Article|
|Keywords:||Familial Hypercholesterolaemia, general practice, preventive healthcare, atherosclerotic cardiovascular disease, cascade testing,|
|Research Division:||Health Sciences|
|Research Group:||Health services and systems|
|Research Field:||General practice|
|Objective Group:||Public health (excl. specific population health)|
|Objective Field:||Preventive medicine|
|UTAS Author:||Radford, J (Professor Jan Radford)|
|Funding Support:||National Health and Medical Research Council (GNT1142883)|
|Web of Science® Times Cited:||6|
|Downloads:||11 View Download Statistics|
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