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Does Routinely Assessing Family History Improve Detection of Patients at High Risk for Cardiovascular Disease? FREE

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The full report is titled “Effect of Adding Systematic Family History Enquiry to Cardiovascular Disease Risk Assessment in Primary Care. A Matched-Pair, Cluster Randomized Trial.” It is in the 21 February 2012 issue of Annals of Internal Medicine (volume 156, pages 253-262). The authors are N. Qureshi, S. Armstrong, P. Dhiman, P. Saukko, J. Middlemass, P.H. Evans, and J. Kai, for the ADDFAM (Added Value of Family History in CVD Risk Assessment) Study Group.

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Ann Intern Med. 2012;156(4):I-38. doi:10.7326/0003-4819-156-4-201202210-00001
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What is the problem and what is known about it so far?

Because family history is a recognized risk factor for many chronic diseases, including cancer, diabetes, and coronary heart disease (CHD), doctors often ask patients about diseases and other health problems that have occurred in their family as part of routine care. By combining family history with other clinical information, doctors can better assess a patient's risk for such diseases. However, evidence is limited on the value of routinely assessing family history in primary care, as well as on the effect of collecting such infor-mation on patients. Self-administered questionnaires on family history are one approach to collecting these data more systematically and, possibly, improving identification of significant familial risk.

Why did the researchers do this particular study?

To evaluate the effect of collecting family history of CHD when assessing cardiovascular risk in primary care.

Who was studied?

748 patients aged 30 to 65 years from 24 family practices in England. The patients had no previously diagnosed cardiovascular risk.

How was the study done?

The practices were organized into 12 pairs of 1 control and 1 intervention practice each. In all practices, medical staff calculated a standard patient risk score for cardiovascular disease by inputting core risk factors (age, sex, smoking status, systolic blood pressure, and the ratio of total to high-density lipoprotein cholesterol levels) into a risk calculator. Doctors usually use this score to estimate a patient's 10-year risk for cardiovascular disease.

In the intervention practices, clinicians also had patients complete a questionnaire to collect information on family history of CHD. The clinicians multiplied a patient's risk score by 1.5 if a family history of premature CHD was identified, because a patient is more likely to develop CHD if he or she has a male sibling or parent younger than 55 years who had CHD or a female sibling or parent younger than 65 years who had CHD.

Doctors invited patients identified as having high cardiovascular risk (≥20% risk in the next 10 years) for a consultation, at which the increased risk was explained and advice was offered on lifestyle changes to reduce risk, such as dietary changes, smoking cessation, and exercise.

What did the researchers find?

When systematic collection of family history was added to usual cardiovascular risk assessment, 5% more persons were identified as having high risk for CHD. High patient response and completion rates suggest that collecting the necessary family history data by using a self-completed questionnaire is possible. The family history intervention did not lead to undue anxiety among the patients.

What were the limitations of the study?

Relatively few participants were from minority or less-educated groups, so the results may not apply to all populations. The study did not explore how being identified as having high risk affected behavioral change and clinical outcomes.

What are the implications of the study?

Routinely collecting family history can improve the identification of patients with high risk for heart disease and may increase the likelihood that they receive preventive care.





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