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  • Title: Improving identification and management of familial hypercholesterolaemia in primary care: Pre- and post-intervention study.
    Author: Weng S, Kai J, Tranter J, Leonardi-Bee J, Qureshi N.
    Journal: Atherosclerosis; 2018 Jul; 274():54-60. PubMed ID: 29751285.
    Abstract:
    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 prescription 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.
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