Improving detection and management of familial hypercholesterolaemia in Australian general practice. Issue 15 (20th May 2021)

• Record Type: Journal Article
• Authors: Brett, Tom; Chan, Dick C; Radford, Jan; Heal, Clare; Gill, Gerard; Hespe, Charlotte; Vargas-Garcia, Cristian; Condon, Carmen; Sheil, Barbara; Li, Ian W; Sullivan, David R; Vickery, Alistair W; Pang, Jing; Arnold-Reed, Diane E; Watts, Gerald F
• Is Part Of: Heart. Volume 107:Issue 15(2021)
• Page Start: 1213
• Page End: 1219
• Publication Date: 2021-05-20
• Subjects: atherosclerosis -- electronic health records -- hyperlipidemias -- global burden of disease -- delivery of healthcare; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2020-318813
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : 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. Trial registration number: 12616000630415.