RT Journal Article
SR Electronic
T1 Improving detection and management of familial hypercholesterolaemia in Australian general practice
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1213
OP 1219
DO 10.1136/heartjnl-2020-318813
VO 107
IS 15
A1 Tom Brett
A1 Dick C Chan
A1 Jan Radford
A1 Clare Heal
A1 Gerard Gill
A1 Charlotte Hespe
A1 Cristian Vargas-Garcia
A1 Carmen Condon
A1 Barbara Sheil
A1 Ian W Li
A1 David R Sullivan
A1 Alistair W Vickery
A1 Jing Pang
A1 Diane E Arnold-Reed
A1 Gerald F Watts
YR 2021
UL http://heart.bmj.com/content/107/15/1213.abstract
AB 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.Data are available on reasonable request.