Improving detection and management of familial hypercholesterolaemia in Australian general practice

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., and Watts, Gerald F. (2021) Improving detection and management of familial hypercholesterolaemia in Australian general practice. Heart, 107 (15). pp. 1213-1219.

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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.

Item ID: 69353
Item Type: Article (Research - C1)
ISSN: 1468-201X
Copyright Information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC partnership grant GNT1142883
Date Deposited: 14 Sep 2021 22:28
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420304 General practice @ 100%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200104 Prevention of human diseases and conditions @ 30%
20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 70%
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