Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study
Background and Aims: Familial hypercholesterolaemia (FH) is a major cause of premature heart disease but remains unrecognised in most patients. This study investigated if a systematic primary care-based approach to identify and manage possible FH improves recommended best clinical practice. Methods...
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| Format: | Article |
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Elsevier
2018
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| Online Access: | https://eprints.nottingham.ac.uk/51490/ |
| _version_ | 1848798508025380864 |
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| author | Weng, Stephen Kai, Joe Tranter, Jennifer Leonardi-Bee, Jo Qureshi, Nadeem |
| author_facet | Weng, Stephen Kai, Joe Tranter, Jennifer Leonardi-Bee, Jo Qureshi, Nadeem |
| author_sort | Weng, Stephen |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background and Aims: Familial hypercholesterolaemia (FH) is a major cause of premature heart disease but remains unrecognised in most patients. This study investigated if a systematic primary care-based approach to identify and manage possible FH improves recommended best clinical practice.
Methods: Pre- and post-intervention study in six UK general practices (population 45,033) which invited patients with total cholesterol >7.5 mmol/L to be assessed for possible FH. Compliance with national guideline recommendations to identify and manage possible FH (repeat cholesterol; assess family history of heart disease; identify secondary causes and clinical features; reduce total & LDL-cholesterol; statin prescribing; lifestyle advice) was assessed by calculating the absolute difference in measures of care pre- and six months post-intervention.
Results: The intervention improved best clinical practice in 118 patients consenting to assessment (of 831 eligible patients): repeat cholesterol test (+75.4%, 95% CI 66.9-82.3); family history of heart disease assessed (+35.6%, 95% CI 27.0-44.2); diagnosis of secondary causes (+7.7%, 95% CI 4.1-13.9), examining clinical features (+6.0%, 95% CI 2.9-11.7). For 32 patients diagnosed with possible FH using Simon-Broome criteria, statin prescribing significantly improved (18.8%, 95% CI 8.9-35.3) with non-significant mean reductions in cholesterol post-intervention (total: -0.16 mmol/L, 95% CI -0.78-0.46; LDL: -0.12 mmol/L, 95% CI -0.81-0.57).
Conclusions: Within six months, this simple primary care intervention improved both identification and management of patients with possible FH, in line with national evidence-based guidelines. Replicating and sustaining this approach across the country could lead to substantial improvement in health outcomes for these individuals with very high cardiovascular risk. |
| first_indexed | 2025-11-14T20:20:53Z |
| format | Article |
| id | nottingham-51490 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T20:20:53Z |
| publishDate | 2018 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-514902020-05-04T19:47:59Z https://eprints.nottingham.ac.uk/51490/ Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study Weng, Stephen Kai, Joe Tranter, Jennifer Leonardi-Bee, Jo Qureshi, Nadeem Background and Aims: Familial hypercholesterolaemia (FH) is a major cause of premature heart disease but remains unrecognised in most patients. This study investigated if a systematic primary care-based approach to identify and manage possible FH improves recommended best clinical practice. Methods: Pre- and post-intervention study in six UK general practices (population 45,033) which invited patients with total cholesterol >7.5 mmol/L to be assessed for possible FH. Compliance with national guideline recommendations to identify and manage possible FH (repeat cholesterol; assess family history of heart disease; identify secondary causes and clinical features; reduce total & LDL-cholesterol; statin prescribing; lifestyle advice) was assessed by calculating the absolute difference in measures of care pre- and six months post-intervention. Results: The intervention improved best clinical practice in 118 patients consenting to assessment (of 831 eligible patients): repeat cholesterol test (+75.4%, 95% CI 66.9-82.3); family history of heart disease assessed (+35.6%, 95% CI 27.0-44.2); diagnosis of secondary causes (+7.7%, 95% CI 4.1-13.9), examining clinical features (+6.0%, 95% CI 2.9-11.7). For 32 patients diagnosed with possible FH using Simon-Broome criteria, statin prescribing significantly improved (18.8%, 95% CI 8.9-35.3) with non-significant mean reductions in cholesterol post-intervention (total: -0.16 mmol/L, 95% CI -0.78-0.46; LDL: -0.12 mmol/L, 95% CI -0.81-0.57). Conclusions: Within six months, this simple primary care intervention improved both identification and management of patients with possible FH, in line with national evidence-based guidelines. Replicating and sustaining this approach across the country could lead to substantial improvement in health outcomes for these individuals with very high cardiovascular risk. Elsevier 2018-07-30 Article PeerReviewed Weng, Stephen, Kai, Joe, Tranter, Jennifer, Leonardi-Bee, Jo and Qureshi, Nadeem (2018) Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study. Atherosclerosis, 274 . pp. 54-60. ISSN 0021-9150 Primary health care; Familial hypercholesterolaemia; Family health; Medical genetics. https://www.sciencedirect.com/science/article/pii/S0021915018302223 doi:10.1016/j.atherosclerosis.2018.04.037 doi:10.1016/j.atherosclerosis.2018.04.037 |
| spellingShingle | Primary health care; Familial hypercholesterolaemia; Family health; Medical genetics. Weng, Stephen Kai, Joe Tranter, Jennifer Leonardi-Bee, Jo Qureshi, Nadeem Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study |
| title | Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study |
| title_full | Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study |
| title_fullStr | Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study |
| title_full_unstemmed | Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study |
| title_short | Improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study |
| title_sort | improving identification & management of familial hypercholesterolaemia in primary care: pre- and post-intervention study |
| topic | Primary health care; Familial hypercholesterolaemia; Family health; Medical genetics. |
| url | https://eprints.nottingham.ac.uk/51490/ https://eprints.nottingham.ac.uk/51490/ https://eprints.nottingham.ac.uk/51490/ |