Integrated guidance for enhancing the care of Familial Hypercholesterolaemia in Australia

Watts, Gerald F., Sullivan, David R., Hare, David L., Kostner, Karam M., Horton, Ari E., Bell, Damon A., Brett, Tom, Trent, Ronald J., Poplawski, Nicola K., Martin, Andrew C., Justo, Robert N., Chow, Clara, and FH Australasia Network Consensus Working Group, (2021) Integrated guidance for enhancing the care of Familial Hypercholesterolaemia in Australia. Heart, Lung and Circulation, 30 (3). pp. 324-349.

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Abstract

Familial hypercholesterolaemia (FH) is a dominant and highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol concentration and, if untreated, leads to premature atherosclerosis and coronary artery disease (CAD). There are approximately 100,000 people with FH in Australia. However, an overwhelming majority of those affected remain undetected and inadequately treated, consistent with FH being a leading challenge for public health genomics. To further address the unmet need, we provide an updated guidance, presented as a series of systematically collated recommendations, on the care of patients and families with FH. These recommendations have been informed by an exponential growth in published works and new evidence over the last 5 years and are compatible with a contemporary global call to action on FH. Recommendations are given on the detection, diagnosis, assessment and management of FH in adults and children. Recommendations are also made on genetic testing and risk notification of biological relatives who should undergo cascade testing for FH. Guidance on management is based on the concepts of risk re-stratification, adherence to heart healthy lifestyles, treatment of non-cholesterol risk factors, and safe and appropriate use of LDL-cholesterol lowering therapies, including statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors and lipoprotein apheresis. Broad recommendations are also provided for the organisation and development of health care services. Recommendations on best practice need to be underpinned by good clinical judgment and shared decision making with patients and families. Models of care for FH need to be adapted to local and regional health care needs and available resources. A comprehensive and realistic implementation strategy, informed by further research, including assessments of cost-benefit, will be required to ensure that this new guidance benefits all Australian families with or at risk of FH

Item ID: 66267
Item Type: Article (Research - C1)
ISSN: 1444-2892
Keywords: Familial hypercholesterolaemia, Guidance, Adults, Children, Diagnosis, Assessment, Genetic testing, Cascade testing, Management, Organisation of care
Copyright Information: © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. Available under a Creative Commons Attribution license.
Date Deposited: 24 Feb 2021 00:19
FoR Codes: 42 HEALTH SCIENCES > 4206 Public health > 420603 Health promotion @ 20%
42 HEALTH SCIENCES > 4206 Public health > 420605 Preventative health care @ 80%
SEO Codes: 20 HEALTH > 2004 Public health (excl. specific population health) > 200412 Preventive medicine @ 40%
20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 60%
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