1
|
Grutters LA, Christiaans I. Cascade genetic counseling and testing in hereditary syndromes: inherited cardiovascular disease as a model: a narrative review. Fam Cancer 2024; 23:155-164. [PMID: 38184510 PMCID: PMC11153290 DOI: 10.1007/s10689-023-00356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
Inherited cardiovascular diseases cover the inherited cardiovascular disease familial hypercholesterolemia and inherited cardiac diseases, like inherited cardiomyopathies and inherited arrhythmia syndromes. Cascade genetic counseling and testing in inherited cardiovascular diseases have had three decades of academic attention. Inherited cardiovascular diseases affect around 1-2% of the population worldwide and cascade genetic counseling and testing are considered valuable since preventive measures and/or treatments are available. Cascade genetic counseling via a family-mediated approach leads to an uptake of genetic counseling and testing among at-risk relatives of around 40% one year after identification of the causal variant in the proband, with uptake remaining far from complete on the long-term. These findings align with uptake rates among relatives at-risk for other late onset medically actionable hereditary diseases, like hereditary cancer syndromes. Previous interventions to increase uptake have focused on optimizing the process of informing relatives through the proband and on contacting relatives directly. However, despite successful information dissemination to at-risk relatives, these approaches had little or no effect on uptake. The limited research into the barriers that impede at-risk relatives from seeking counseling has revealed knowledge, attitudinal, social and practical barriers but it remains unknown how these factors contribute to the decision-making process for seeking counseling in at-risk relatives. A significant effect on uptake of genetic testing has only been reached in the setting of familial hypercholesterolemia, where active information provision was accompanied by a reduction of health-system-related barriers. We propose that more research is needed on barriers -including health-system-related barriers- and how they hinder counseling and testing in at-risk relatives, so that uptake can be optimized by (adjusted) interventions.
Collapse
Affiliation(s)
- Laura A Grutters
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, 9700 RB, The Netherlands
| | - Imke Christiaans
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, 9700 RB, The Netherlands.
| |
Collapse
|
2
|
Tiller J, Bakshi A, Dowling G, Keogh L, McInerney-Leo A, Barlow-Stewart K, Boughtwood T, Gleeson P, Delatycki MB, Winship I, Otlowski M, Lacaze P. Community concerns about genetic discrimination in life insurance persist in Australia: A survey of consumers offered genetic testing. Eur J Hum Genet 2024; 32:286-294. [PMID: 37169978 PMCID: PMC10923945 DOI: 10.1038/s41431-023-01373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/16/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
Fears of genetic discrimination in life insurance continue to deter some Australians from genetic testing. In July 2019, the life insurance industry introduced a partial, self-regulated moratorium restricting the use of genetic results in underwriting, applicable to policies up to certain limits (eg AUD$500,000 for death cover).We administered an online survey to consumers who had taken, or been offered, clinical genetic testing for adult-onset conditions, to gather views and experiences about the moratorium and the use of genetic results in life insurance, including its regulation.Most respondents (n = 367) had undertaken a genetic test (89%), and had a positive test result (76%; n = 243/321). Almost 30% (n = 94/326) reported testing after 1 July 2019. Relatively few respondents reported knowing about the moratorium (16%; n = 54/340) or that use of genetic results in life insurance underwriting is legal (17%; n = 60/348). Only 4% (n = 14/350) consider this practice should be allowed. Some respondents reported ongoing difficulties accessing life insurance products, even after the moratorium. Further, discrimination concerns continue to affect some consumers' decision-making about having clinical testing and applying for life insurance products, despite the Moratorium being in place. Most respondents (88%; n = 298/340) support the introduction of legislation by the Australian government to regulate this issue.Despite the introduction of a partial moratorium in Australia, fears of genetic discrimination persist, and continue to deter people from genetic testing. Consumers overwhelmingly consider life insurers should not be allowed to use genetic results in underwriting, and that federal legislation is required to regulate this area.
Collapse
Affiliation(s)
- Jane Tiller
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Murdoch Children's Research Institute, Parkville, Australia.
- Australian Genomics, Melbourne, Australia.
| | - Andrew Bakshi
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Grace Dowling
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, Australia
- Australian Genomics, Melbourne, Australia
| | | | - Martin B Delatycki
- Murdoch Children's Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Ingrid Winship
- Department of Medicine, the University of Melbourne, Melbourne, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, Australia
| | - Paul Lacaze
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
3
|
Kinnamon DD, Jordan E, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Aaronson KD, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Huggins GS, Ni H, Burke W, Hershberger RE. Effectiveness of the Family Heart Talk Communication Tool in Improving Family Member Screening for Dilated Cardiomyopathy: Results of a Randomized Trial. Circulation 2023; 147:1281-1290. [PMID: 36938756 PMCID: PMC10133091 DOI: 10.1161/circulationaha.122.062507] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/15/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Managing disease risk among first-degree relatives of probands diagnosed with a heritable disease is central to precision medicine. A critical component is often clinical screening, which is particularly important for conditions like dilated cardiomyopathy (DCM) that remain asymptomatic until severe disease develops. Nonetheless, probands are frequently ill-equipped to disseminate genetic risk information that motivates at-risk relatives to complete recommended clinical screening. An easily implemented remedy for this key issue has been elusive. METHODS The DCM Precision Medicine Study developed Family Heart Talk, a booklet designed to help probands with DCM communicate genetic risk and the need for cardiovascular screening to their relatives. The effectiveness of the Family Heart Talk booklet in increasing cardiovascular clinical screening uptake among first-degree relatives was assessed in a multicenter, open-label, cluster-randomized, controlled trial. The primary outcome measured in eligible first-degree relatives was completion of screening initiated within 12 months after proband enrollment. Because probands randomized to the intervention received the booklet at the enrollment visit, eligible first-degree relatives were limited to those who were alive the day after proband enrollment and not enrolled on the same day as the proband. RESULTS Between June 2016 and March 2020, 1241 probands were randomized (1:1) to receive Family Heart Talk (n=621) or not (n=620) within strata defined by site and self-identified race/ethnicity (non-Hispanic Black, non-Hispanic White, or Hispanic). Final analyses included 550 families (n=2230 eligible first-degree relatives) in the Family Heart Talk arm and 561 (n=2416) in the control arm. A higher percentage of eligible first-degree relatives completed screening in the Family Heart Talk arm (19.5% versus 16.0%), and the odds of screening completion among these first-degree relatives were higher in the Family Heart Talk arm after adjustment for proband randomization stratum, sex, and age quartile (odds ratio, 1.30 [1-sided 95% CI, 1.08-∞]). A prespecified subgroup analysis did not find evidence of heterogeneity in the adjusted intervention odds ratio across race/ethnicity strata (P=0.90). CONCLUSIONS Family Heart Talk, a booklet that can be provided to patients with DCM by clinicians with minimal additional time investment, was effective in increasing cardiovascular clinical screening among first-degree relatives of these patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03037632.
Collapse
Affiliation(s)
- Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE
| | | | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston TX
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA
| | - Salpy V. Pamboukian
- University of Alabama, Birmingham, AL; current address, University of Washington, Seattle, WA
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, AZ; current address, Division of Cardiology, Washington University, St. Louis, MO
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stuart Katz
- New York University Langone Medical Center, New York, NY
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, NY
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, FL
| | | | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | | |
Collapse
|
4
|
Burns C, Yeates L, Sweeting J, Semsarian C, Ingles J. Evaluating a communication aid for return of genetic results in families with hypertrophic cardiomyopathy: A randomized controlled trial. J Genet Couns 2023; 32:425-434. [PMID: 36385718 PMCID: PMC10946474 DOI: 10.1002/jgc4.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 09/28/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022]
Abstract
Genetic testing for hypertrophic cardiomyopathy (HCM) is considered a key aspect of management. Communication of genetic test results to the proband and their family members, can be a barrier to effective uptake. We hypothesized that a communication aid would facilitate effective communication, and sought to evaluate knowledge and communication of HCM risk to at-risk relatives. This was a prospective randomized controlled trial. Consecutive HCM patients attending a specialized clinic, who agreed to participate, were randomized to the intervention or current clinical practice. The intervention consisted of a genetic counselor-led appointment, separate to their clinical cardiology review, and guided by a communication booklet which could be written in and taken home. Current clinical practice was defined as the return of the genetic result by a genetic counselor and cardiologist, often as part of a clinical cardiology review. The primary outcome was the ability and confidence of the individual to communicate genetic results to at-risk relatives. The a priori outcome of improved communication among HCM families did not show statistically significant differences between the control and intervention group, though the majority of probands in the intervention group achieved fair communication (n = 13/22) and had higher genetic knowledge scores than those in the control group (7 ± 3 versus 6 ± 3). A total of 29% of at-risk relatives were not informed of a genetic result in their family. Communication among HCM families remains challenging, with nearly a third of at-risk relatives not informed of a genetic result. We show a significant gap in the current approach to supporting family communication about genetics. Australian New Zealand Clinical Trials Registry: ACTRN12617000706370.
Collapse
Affiliation(s)
- Charlotte Burns
- Agnes Ginges Centre for Molecular Cardiology at Centenary InstituteThe University of SydneySydneyAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Laura Yeates
- Agnes Ginges Centre for Molecular Cardiology at Centenary InstituteThe University of SydneySydneyAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Joanna Sweeting
- Cardio Genomics Program at Centenary InstituteThe University of SydneySydneyAustralia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary InstituteThe University of SydneySydneyAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Jodie Ingles
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
- Cardio Genomics Program at Centenary InstituteThe University of SydneySydneyAustralia
| |
Collapse
|
5
|
Cirino AL, Harris SL, Murad AM, Hansen B, Malinowski J, Natoli JL, Kelly MA, Christian S. The uptake and utility of genetic testing and genetic counseling for hypertrophic cardiomyopathy-A systematic review and meta-analysis. J Genet Couns 2022; 31:1290-1305. [PMID: 35799446 DOI: 10.1002/jgc4.1604] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
Genetic testing and genetic counseling are routinely indicated for patients with hypertrophic cardiomyopathy (HCM); however, the uptake and utility of these services is not entirely understood. This systematic review and meta-analysis summarizes the uptake and utility of genetic counseling and genetic testing for patients with HCM and their at-risk family members, as well as the impact of genetic counseling/testing on patient-reported outcomes (PROs). A systematic search was performed through March 12, 2021. Meta-analyses were performed whenever possible; other findings were qualitatively summarized. Forty-eight studies met inclusion criteria (47 observational, 1 randomized). Uptake of genetic testing in probands was 57% (95% confidence interval [CI]: 40, 73). Uptake of cascade screening for at-risk relatives were as follows: 61% for cascade genetic testing (95% CI: 45, 75), 58% for cardiac screening (e.g. echocardiography) (95% CI: 40, 73), and 69% for either/both approaches (95% CI: 43, 87). In addition, relatives of probands with a positive genetic test result were significantly more likely to undergo cascade screening compared to relatives of probands with a negative result (odds ratio = 3.17, 95% CI: 2.12, 4.76). Overall, uptake of genetic counseling in both probands and relatives ranged from 37% to 84%. Multiple studies found little difference in PROs between individuals receiving positive versus negative genetic test results; however, other studies found that individuals with positive genetic test results experienced worse psychological outcomes. Genetic testing may also inform life choices, particularly decisions related to reproduction and insurance. Genetic counseling was associated with high satisfaction, increased perceived personal control and empowerment, and decreased anxiety. Approximately half to three-quarters of patients with HCM and their relatives undergo genetic testing or cascade screening. PROs after genetic testing varied and genetic counseling was associated with high satisfaction and improved PROs.
Collapse
Affiliation(s)
- Allison L Cirino
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Stephanie L Harris
- Cardiovascular Genetics Program, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea M Murad
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Brittany Hansen
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jaime L Natoli
- Kaiser Permanente, Southern California Permanente Medical Group, Pasadena, California, USA
| | - Melissa A Kelly
- Geisinger, Genomic Medicine Institute, Danville, Pennsylvania, USA
| | - Susan Christian
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
6
|
A tailored approach to informing relatives at risk of inherited cardiac conditions: results of a randomised controlled trial. Eur J Hum Genet 2022; 30:203-210. [PMID: 34815540 PMCID: PMC8821591 DOI: 10.1038/s41431-021-00993-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023] Open
Abstract
If undetected, inherited cardiac conditions can lead to sudden cardiac death, while treatment options are available. Predictive DNA testing is therefore advised for at-risk relatives, and probands are currently asked to inform relatives about this. However, fewer than half of relatives attend genetic counselling. In this trial, we compared a tailored approach to informing relatives, in which probands were asked whether they preferred relatives to be informed by themselves or by the genetic counsellor, with current practice. Our primary outcome was uptake of genetic counselling in relatives in the first year after test result disclosure. Secondary outcomes were evaluation of the approach and impact on psychological/family functioning measured 3 (T1) and 9 (T2) months post-disclosure via telephone interviews and questionnaires. We included 96 probands; 482 relatives were eligible for counselling and genetic testing. We observed no significant difference in uptake of genetic counselling between the control (38%) and the intervention (37%) group (p = 0.973). Nor were there significant differences between groups in impact on family/psychological functioning. Significantly more probands in the tailored group were satisfied (p = 0.001) and felt supported (p = 0.003) by the approach, although they also felt somewhat coerced to inform relatives (p < 0.001) and perceived room for improvement (p < 0.001). To conclude, we observed no differences in uptake and impact on family/psychological functioning between the current and tailored approach, but probands in the tailored group more often felt satisfied. Further research on barriers to relatives attending genetic counselling and on how to optimize the provision of a tailored approach is needed.
Collapse
|
7
|
Christian S, Welsh A, Yetman J, Birch P, Bartels K, Burnell L, Curtis F, Huculak C, Zahavich L, Arbor L, Marcadier J, Atallah J. Development and evaluation of decision aids to guide families' predictive testing choices for children at risk for arrhythmia or cardiomyopathy. Can J Cardiol 2021; 37:1586-1592. [PMID: 34147624 DOI: 10.1016/j.cjca.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/12/2021] [Accepted: 05/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Assessing the issues surrounding predictive genetic testing for children at risk of an inherited arrythmia or cardiomyopathy is complex. The objective of this study was to design and evaluate four cardiac decision aids. The decision aids were developed to assist families with a genetic diagnosis of long QT syndrome, hypertrophic cardiomyopathy, dilated cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy in deciding between predictive genetic testing and cardiac screening for their children. METHOD/RESULTS The decision aids were developed using the International Patient Decision Aid Standards framework and revised based on feedback from individuals with lived experience, genetic counsellors and other healthcare professionals. Response to the decision aids was positive and acceptability and understandability scores were high. CONCLUSION The decision aids can be used before, during or following a genetic counselling appointment as a resource or to guide discussion. These tools permit a balanced and consistent approach to the decision-making process, with a focus on the importance families place on the advantages and disadvantages of each option.
Collapse
Affiliation(s)
| | | | | | - Patrician Birch
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Bartels
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Fiona Curtis
- Eastern Health, St. John's, Newfoundland, Canada
| | | | | | - Laura Arbor
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | |
Collapse
|
8
|
Tiller J, McInerney-Leo A, Belcher A, Boughtwood T, Gleeson P, Delatycki M, Barlow-Stewart K, Winship I, Otlowski M, Keogh L, Lacaze P. Study protocol: the Australian genetics and life insurance moratorium-monitoring the effectiveness and response (A-GLIMMER) project. BMC Med Ethics 2021; 22:63. [PMID: 34020638 PMCID: PMC8138092 DOI: 10.1186/s12910-021-00634-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background The use of genetic test results in risk-rated insurance is a significant concern internationally, with many countries banning or restricting the use of genetic test results in underwriting. In Australia, life insurers’ use of genetic test results is legal and self-regulated by the insurance industry (Financial Services Council (FSC)). In 2018, an Australian Parliamentary Inquiry recommended that insurers’ use of genetic test results in underwriting should be prohibited. In 2019, the FSC introduced an industry self-regulated moratorium on the use of genetic test results. In the absence of government oversight, it is critical that the impact, effectiveness and appropriateness of the moratorium is monitored. Here we describe the protocol of our government-funded research project, which will serve that critical function between 2020 and 2023. Methods A realist evaluation framework was developed for the project, using a context-mechanism-outcome (CMO) approach, to systematically assess the impact of the moratorium for a range of stakeholders. Outcomes which need to be achieved for the moratorium to accomplish its intended aims were identified, and specific data collection measures methods were developed to gather the evidence from relevant stakeholder groups (consumers, health professionals, financial industry and genetic research community) to determine if aims are achieved. Results from each arm of the study will be analysed and published in peer-reviewed journals as they become available. Discussion The A-GLIMMER project will provide essential monitoring of the impact and effectiveness of the self-regulated insurance moratorium. On completion of the study (3 years) a Stakeholder Report will be compiled. The Stakeholder Report will synthesise the evidence gathered in each arm of the study and use the CMO framework to evaluate the extent to which each of the outcomes have been achieved, and make evidence-based recommendations to the Australian federal government, life insurance industry and other stakeholders. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00634-2.
Collapse
Affiliation(s)
- Jane Tiller
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,Murdoch Children's Research Institute, Parkville, VIC, Australia. .,Victorian Clinical Genetics Services, Parkville, VIC, Australia.
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, The University of Queensland Dermatology Research Centre, Brisbane, QLD, Australia
| | - Andrea Belcher
- Australian Genomics, Parkville, VIC, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Australian Genomics, Parkville, VIC, Australia
| | | | - Martin Delatycki
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Victorian Clinical Genetics Services, Parkville, VIC, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ingrid Winship
- Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Paul Lacaze
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
9
|
van den Heuvel LM, van Teijlingen MO, van der Roest W, van Langen IM, Smets EMA, van Tintelen JP, Christiaans I. Long-Term Follow-Up Study on the Uptake of Genetic Counseling and Predictive DNA Testing in Inherited Cardiac Conditions. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:524-530. [PMID: 33079600 PMCID: PMC7889286 DOI: 10.1161/circgen.119.002803] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Supplemental Digital Content is available in the text. Inherited cardiac conditions present with a wide range of symptoms and may even result in sudden cardiac death. Relatives of probands with a confirmed pathogenic genetic variant are advised predictive DNA testing to enable prevention and treatment. In 2 previous cohort studies of 115 probands with a pathogenic variant, family uptake of genetic counseling was assessed in the first year(s) after test result disclosure to the proband. This study assesses uptake in these cohorts in the 14 to 23 years following disclosure.
Collapse
Affiliation(s)
- Lieke M van den Heuvel
- Department of Clinical Genetics (L.M.v.d.H., M.O.v.T., J.P.v.T., I.C.), Amsterdam UMC, University of Amsterdam.,Netherlands Heart Institute, Utrecht (L.M.v.d.H.).,Department of Genetics, University Medical Center Utrecht, Utrecht University (L.M.v.d.H., J.P.v.T.)
| | - Maxiem O van Teijlingen
- Department of Clinical Genetics (L.M.v.d.H., M.O.v.T., J.P.v.T., I.C.), Amsterdam UMC, University of Amsterdam
| | - Wilma van der Roest
- Department of Clinical Genetics, University Medical Center Groningen/University of Groningen, the Netherlands (W.v.d.R., I.M.v.L., I.C.)
| | - Irene M van Langen
- Department of Clinical Genetics, University Medical Center Groningen/University of Groningen, the Netherlands (W.v.d.R., I.M.v.L., I.C.)
| | - Ellen M A Smets
- Department of Medical Psychology (E.M.A.S.), Amsterdam UMC, University of Amsterdam
| | - J Peter van Tintelen
- Department of Clinical Genetics (L.M.v.d.H., M.O.v.T., J.P.v.T., I.C.), Amsterdam UMC, University of Amsterdam.,Department of Genetics, University Medical Center Utrecht, Utrecht University (L.M.v.d.H., J.P.v.T.)
| | - Imke Christiaans
- Department of Clinical Genetics (L.M.v.d.H., M.O.v.T., J.P.v.T., I.C.), Amsterdam UMC, University of Amsterdam.,Department of Clinical Genetics, University Medical Center Groningen/University of Groningen, the Netherlands (W.v.d.R., I.M.v.L., I.C.)
| |
Collapse
|
10
|
Hadley DW, Eliezer D, Addissie Y, Goergen A, Ashida S, Koehly L. Uptake and predictors of colonoscopy use in family members not participating in cascade genetic testing for Lynch syndrome. Sci Rep 2020; 10:15959. [PMID: 32994442 PMCID: PMC7525436 DOI: 10.1038/s41598-020-72938-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/03/2020] [Indexed: 11/09/2022] Open
Abstract
Cascade genetic testing provides a method to appropriately focus colonoscopy use in families with Lynch syndrome (LS). However, research suggests that up to two-thirds at risk to inherit LS don’t participate. Within the United States, no studies have assessed colonoscopy use within this elusive and high-risk subset. We set forth to (1) document colonoscopy use within those not undergoing genetic testing (NGT) and (2) identify factors associated with completing colonoscopy. Data came from a cross sectional survey of families with molecularly confirmed LS. One hundred seventy-six (176) adults participated; 47 of unknown variant status and 129 with variant status known (59 carriers/70 non-carriers). Despite a high level of awareness of LS (85%) and identical recommendations for colonoscopy, NGT reported significantly lower use of colonoscopy than carriers (47% vs. 73%; p = 0.003). Our results show that perceived risk to develop colon cancer (AOR = 1.99, p < 0.05) and physician recommendations (AOR = 7.64, p < 0.01) are significant predictors of colonoscopy use across all family members controlling for carrier status. Given these findings, health care providers, should assess patients’ perceived risk to develop cancer, assist them in adjusting risk perceptions and discuss recommendations for colonoscopy with all members in families with LS. Trial Registration Clinical Trials.gov Identifier: NCT00004210.
Collapse
Affiliation(s)
- Donald W Hadley
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, 35 Convent Drive, MSC 3717, Bldg. 35, Room 1B205, Bethesda, MD, 20892-3717, USA.
| | - Dina Eliezer
- Social Networks Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yonit Addissie
- Social Networks Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Goergen
- Social Networks Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sato Ashida
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Laura Koehly
- Social Networks Methods Section, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
11
|
Paratz E, Semsarian C, La Gerche A. Mind the gap: Knowledge deficits in evaluating young sudden cardiac death. Heart Rhythm 2020; 17:2208-2214. [PMID: 32721478 DOI: 10.1016/j.hrthm.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
Sudden cardiac arrest affects around half a million people aged under 50 years old annually, with a 90% mortality rate. Despite high patient numbers and clear clinical need to improve outcomes, many gaps exist in the evidence underpinning patients' management. Domains identifying the greatest barriers to conducting trials are the prehospital and forensic settings, which also provide care to the majority of patients. Addressing gaps in evidence along each point of the cardiac arrest trajectory is a key clinical priority.
Collapse
Affiliation(s)
- Elizabeth Paratz
- Clinical Research Domain, Baker Heart & Diabetes Institute, Melbourne, Australia; National Centre for Sports Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia.
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart & Diabetes Institute, Melbourne, Australia; National Centre for Sports Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| |
Collapse
|
12
|
Platt J. A Person-Centered Approach to Cardiovascular Genetic Testing. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036624. [PMID: 31570390 DOI: 10.1101/cshperspect.a036624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiovascular genetic counselors provide guidance to people facing the reality or prospect of inherited cardiovascular conditions. Key activities in this role include discussing clinical cardiac screening for at-risk family members and offering genetic testing. Psychological factors often influence whether patients choose to have genetic testing and how they understand and communicate the results to at-risk relatives, so psychological counseling increases the impact of genetic education and medical recommendations. This work reviews the literature on the factors that influence patient decisions about cardiovascular genetic testing and the psychological impact of results on people who opt to test. It also models use of a psychological framework to apply themes from the literature to routine cardiovascular genetic counseling practice. Modifications of the framework are provided to show how it can be adapted to serve the needs of both new and experienced genetic counselors.
Collapse
Affiliation(s)
- Julia Platt
- Stanford Center for Inherited Cardiovascular Disease, Falk Cardiovascular Research Center, Stanford, California 94305, USA
| |
Collapse
|
13
|
The personal utility and uptake of genomic sequencing in pediatric and adult conditions: eliciting societal preferences with three discrete choice experiments. Genet Med 2020; 22:1311-1319. [PMID: 32371919 PMCID: PMC7394876 DOI: 10.1038/s41436-020-0809-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/09/2022] Open
Abstract
Purpose To estimate the personal utility and uptake of genomic sequencing (GS) across pediatric and adult-onset genetic conditions. Methods Three discrete choice experiment (DCE) surveys were designed and administered to separate representative samples of the Australian public. Bayesian D-efficient explicit partial profile designs were used. Choice data were analyzed using a panel error component random parameter logit model. Results Overall, 1913 participants completed the pediatric (n = 533), symptomatic adult (n = 700) and at-risk adult (n = 680) surveys. The willingness-to-pay for GS information in pediatric conditions was estimated at $5470–$15,250 (US$3830–$10,675) depending on the benefits of genomic information. Uptake ranged between 60% and 81%. For symptomatic adults, the value of GS was estimated at $1573–$8102 (US$1100–$5671) and uptake at 34–82%. For at-risk adults, GS was valued at $2036–$5004 (US$1425–$3503) and uptake was predicted at 35–61%. Conclusion There is substantial personal utility in GS, particularly for pediatric conditions. Personal utility increased as the perceived benefits of genomic information increased. The clinical and regulatory context, and individuals’ sociodemographic and attitudinal characteristics influenced the value and uptake of GS. Society values highly the diagnostic, clinical, and nonclinical benefits of GS. The personal utility of GS should be considered in health-care decision-making.
Collapse
|
14
|
Marleen van den Heuvel L, Stemkens D, van Zelst-Stams WAG, Willeboordse F, Christiaans I. How to inform at-risk relatives? Attitudes of 1379 Dutch patients, relatives, and members of the general population. J Genet Couns 2019; 29:786-799. [PMID: 31889383 PMCID: PMC7649718 DOI: 10.1002/jgc4.1206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/17/2019] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
The uptake of predictive DNA testing in families with a hereditary disease is <50%. Current practice often relies on the proband to inform relatives about the possibility of predictive DNA testing, but not all relatives are informed adequately. To enable informed decision-making concerning predictive DNA testing, the approach used to inform at-risk relatives needs to be optimized. This study investigated the preferences of patients, relatives, and the general population from the Netherlands on how to inform relatives at risk of autosomal dominant diseases. Online surveys were sent to people with autosomal dominant neuro-, onco-, or cardiogenetic diseases and their relatives via patient organizations (n = 379), and to members of the general population via a commercial panel (n = 1,000). Attitudes of the patient and population samples generally corresponded. A majority believed that initially only first-degree relatives should be informed, following the principles of a cascade screening approach. Most participants also thought that probands and healthcare professionals (HCPs) should be involved in informing relatives, and a large proportion believed that HCPs should contact relatives directly in cases where patients are unwilling to inform, both for untreatable and treatable conditions. Participants from the patient sample were of the opinion that HCPs should actively offer support. Our findings show that both patients and HCPs should be involved in informing at-risk relatives of autosomal dominant diseases and suggest that relatives' 'right to know' was considered a dominant issue by the majority of participants. Further research is needed on how to increase proactive support in informing of at-risk relatives.
Collapse
Affiliation(s)
- Lieke Marleen van den Heuvel
- Department of Clinical Genetics, Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Daphne Stemkens
- VSOP Dutch Patient Alliance for Rare and Genetic Diseases, Soest, The Netherlands
| | - Wendy A G van Zelst-Stams
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center/Radboud University, Nijmegen, The Netherlands
| | | | - Imke Christiaans
- Department of Clinical Genetics, Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands.,Department of Genetics, University Medical Center Groningen/University of Groningen, Groningen, The Netherlands
| |
Collapse
|
15
|
Harris S, Cirino AL, Carr CW, Tafessu HM, Parmar S, Greenberg JO, Szent-Gyorgyi LE, Ghazinouri R, Glowny MG, McNeil K, Kaynor EF, Neumann C, Seidman CE, MacRae CA, Ho CY, Lakdawala NK. The uptake of family screening in hypertrophic cardiomyopathy and an online video intervention to facilitate family communication. Mol Genet Genomic Med 2019; 7:e940. [PMID: 31482667 PMCID: PMC6825857 DOI: 10.1002/mgg3.940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Individuals with hypertrophic cardiomyopathy (HCM), even when asymptomatic, are at‐risk for sudden cardiac death and stroke from arrhythmias, making it imperative to identify individuals affected by this familial disorder. Consensus guidelines recommend that first‐degree relatives (FDRs) of a person with HCM undergo serial cardiovascular evaluations. Methods We determined the uptake of family screening in patients with HCM and developed an online video intervention to facilitate family communication and screening. Family screening and genetic testing data were collected through a prospective quality improvement initiative, a standardized clinical assessment and management plan (SCAMP), utilized in an established cardiovascular genetics clinic. Patients were prescribed an online video if screening of their FDRs was incomplete and a pilot study on video utilization and family communication was conducted. Results Two‐hundred and sixteen probands with HCM were enrolled in SCAMP Phase I and 190 were enrolled in SCAMP Phase II. In both phases, probands reported that 51% of FDRs had been screened (382/749 in Phase I, 258/504 in Phase II). Twenty patients participated in a pilot study on video utilization and family communication. Nine participants reported watching the video and six participants reported sharing the video with relatives; however only one participant reported sharing the video with relatives who were not yet aware of the diagnosis of HCM in the family. Conclusion Despite care in a specialized cardiovascular genetics clinic, approximately one half of FDRs of patients with HCM remained unscreened. Online interventions and videos may serve as supplemental tools for patients communicating genetic risk information to relatives.
Collapse
Affiliation(s)
- Stephanie Harris
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison L Cirino
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christina W Carr
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hiwot M Tafessu
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Siddharth Parmar
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Roya Ghazinouri
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle G Glowny
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kara McNeil
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Efthalia F Kaynor
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Catherine Neumann
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine E Seidman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Calum A MacRae
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neal K Lakdawala
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
16
|
|
17
|
van den Heuvel LM, Hoedemaekers YM, Baas AF, van Tintelen JP, Smets EMA, Christiaans I. A tailored approach towards informing relatives at risk of inherited cardiac conditions: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e025660. [PMID: 31289060 PMCID: PMC6615798 DOI: 10.1136/bmjopen-2018-025660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In current practice, probands are asked to inform relatives about the possibility of predictive DNA testing when a pathogenic variant causing an inherited cardiac condition (ICC) is identified. Previous research on the uptake of genetic counselling and predictive DNA testing in relatives suggests that not all relatives are sufficiently informed. We developed a randomised controlled trial to evaluate the effectiveness of a tailored approach in which probands decide together with the genetic counsellor which relatives they inform themselves and which relatives they prefer to have informed by the genetic counsellor. Here, we present the study protocol of this randomised controlled trial. METHODS A multicentre randomised controlled trial with parallel-group design will be conducted in which an intervention group receiving the tailored approach will be compared with a control group receiving usual care. Adult probands diagnosed with an ICC in whom a likely pathogenic or pathogenic variant is identified will be randomly assigned to the intervention or control group (total sample: n=85 probands). Primary outcomes are uptake of genetic counselling and predictive DNA testing by relatives (total sample: n=340 relatives). Secondary outcomes are appreciation of the approach used and impact on familial and psychological functioning, which will be assessed using questionnaires. Relatives who attend genetic counselling will be asked to fill out a questionnaire as well. ETHICS AND DISSEMINATION Ethical approval was obtained from the Medical Ethical Committee of the Amsterdam University Medical Centres (MEC 2017-145), the Netherlands. All participants will provide informed consent prior to participation in the study. Results of the study on primary and secondary outcome measures will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NTR6657; Pre-results.
Collapse
Affiliation(s)
- Lieke M van den Heuvel
- Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Yvonne M Hoedemaekers
- Department of Clinical Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annette F Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Peter van Tintelen
- Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Imke Christiaans
- Department of Clinical Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Houdayer F, Putois O, Babonneau ML, Chaumet H, Joly L, Juif C, Michon CC, Staraci S, Cretin E, Delanoue S, Charron P, Chassagne A, Edery P, Gautier E, Lapointe AS, Thauvin-Robinet C, Sanlaville D, Gargiulo M, Faivre L. Secondary findings from next generation sequencing: Psychological and ethical issues. Family and patient perspectives. Eur J Med Genet 2019; 62:103711. [PMID: 31265899 DOI: 10.1016/j.ejmg.2019.103711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 06/04/2019] [Accepted: 06/28/2019] [Indexed: 01/25/2023]
Abstract
Access to active search for actionable secondary findings (SF) in diagnostic practice is a major psychological and ethical issue for genomic medicine. In this study, we analyzed the preferences of patients and their families regarding SF and identified the reporting procedures necessary for informed consent. We interviewed parents of patients with undiagnosed rare diseases potentially eligible for exome sequencing and patients affected by the diseases listed in the ACMG recommendations. Four focus groups (FG) were formed: parents of patients with undiagnosed rare diseases (FG1, n = 5); patients with hereditary cancers (FG2, n = 10); patients with hereditary cardiac conditions (FG3, n = 3); and patients with metabolic diseases (FG4, n = 3). Psychologists presented three broad topics for discussion: 1. Favorable or not to SF access, 2. Reporting procedures, 3. Equity of access. Discussions were recorded and analyzed using simplified Grounded Theory. Overall, 8 participants declared being favorable to SF because of the medical benefit (mainly FG1); 11 were unfavorable because of the psychological consequences (mainly FG2, FG3, FG4); 2 were ambivalent. The possibility of looking for SF in minors was debated. The 4 key information-based issues for participants ranked as follows: explanation of SF issues, autonomy of choice, importance of a reflection period, and quality of interactions between patients and professionals. Examining equity of access to SF led to philosophical discussions on quality of life. In conclusion, individual experience and life context (circumstances) were decisive in participants' expectations and fears regarding access to SF. Additional longitudinal studies based on actual SF disclosure announcements are needed to establish future guidelines.
Collapse
Affiliation(s)
- F Houdayer
- Genetics Department, Reference Centre for Developmental Disorders Centre East, HCL, Bron, France; Université de Paris, PCPP, F-92100 Boulogne-Billancourt, France
| | - O Putois
- SuLiSoM EA 3071, Univ. Strasbourg, France; Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France
| | | | - H Chaumet
- Genetics Department, Oncogenetics, HCL, Bron, France
| | - L Joly
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France
| | - C Juif
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France
| | - C C Michon
- Filière Cardiogen, GH APHP, Paris, France
| | - S Staraci
- Genetics Department, Reference Centre for Hereditary Cardiac Disorders, GH APHP, Paris, France; Clinical Psychology Laboratory, Psychopathology, Psychoanalysis (EA4056), Univ. Paris Descartes, Sorbonne Paris Cité, France
| | - E Cretin
- CIC, 1431 INSERM, CHU Besançon, France; Philosophy Laboratory « Logiques de l'Agir » EA2274, Univ. Bourgogne Franche-Comté, Besançon, France
| | | | - P Charron
- Filière Cardiogen, GH APHP, Paris, France; Genetics Department, Reference Centre for Hereditary Cardiac Disorders, GH APHP, Paris, France
| | - A Chassagne
- CIC, 1431 INSERM, CHU Besançon, France; FHU TRANSLAD, Dijon University Hospital, France
| | - P Edery
- Genetics Department, Reference Centre for Developmental Disorders Centre East, HCL, Bron, France; INSERM U1028, CNRS UMR5292, CRNL, GENDEV Team, Univ. Claude Bernard Lyon 1, Bron, France
| | - E Gautier
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France
| | | | - C Thauvin-Robinet
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France; FHU TRANSLAD, Dijon University Hospital, France
| | - D Sanlaville
- Genetics Department, Reference Centre for Developmental Disorders Centre East, HCL, Bron, France; INSERM U1028, CNRS UMR5292, CRNL, GENDEV Team, Univ. Claude Bernard Lyon 1, Bron, France
| | - M Gargiulo
- Université de Paris, PCPP, F-92100 Boulogne-Billancourt, France; Institute of Myology, GH APHP, Paris, France
| | - L Faivre
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France; FHU TRANSLAD, Dijon University Hospital, France.
| |
Collapse
|
19
|
Catchpool M, Ramchand J, Martyn M, Hare DL, James PA, Trainer AH, Knight J, Goranitis I. A cost-effectiveness model of genetic testing and periodical clinical screening for the evaluation of families with dilated cardiomyopathy. Genet Med 2019; 21:2815-2822. [PMID: 31222143 PMCID: PMC6892743 DOI: 10.1038/s41436-019-0582-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/31/2019] [Indexed: 11/11/2022] Open
Abstract
Purpose To assess the relative cost-effectiveness of cascade genetic testing in asymptomatic relatives of patients with dilated cardiomyopathy (DCM) compared with periodical clinical surveillance. Methods A decision-analytic model, combining a decision tree and a Markov model, was used to determine the lifetime costs and quality-adjusted life years (QALYs) for the two strategies. Deterministic and probabilistic sensitivity analyses were undertaken to assess the robustness of findings and to explore decision uncertainty. Results The incremental cost per additional QALY of cascade genetic testing prior to periodical clinical surveillance of first-degree relatives compared with periodical clinical surveillance alone was estimated at approximately AUD $6100. At established thresholds of cost-effectiveness, there is a 90% probability that cascade genetic testing is cost-effective. Extensive sensitivity analyses, including the addition of second-degree relatives, did not alter the conclusions drawn from the main analysis. Conclusion Using cascade genetic testing to guide clinical surveillance of asymptomatic relatives of patients with DCM is very likely to be cost-effective. As the DCM pathogenic variant detection rate rises and new evidence for personalized treatment of at-risk individuals becomes available, the cost-effectiveness of cascade testing will further increase.
Collapse
Affiliation(s)
- Max Catchpool
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jay Ramchand
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia.,Melbourne Genomics Health Alliance, Melbourne, VIC, Australia
| | - Melissa Martyn
- Melbourne Genomics Health Alliance, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Paul A James
- Genomic Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Alison H Trainer
- Genomic Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Josh Knight
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ilias Goranitis
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia. .,Australian Genomics Health Alliance, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| |
Collapse
|
20
|
Knight LM, Miller E, Kovach J, Arscott P, von Alvensleben JC, Bradley D, Valdes SO, Ware SM, Meyers L, Travers CD, Campbell RM, Etheridge SP. Genetic testing and cascade screening in pediatric long QT syndrome and hypertrophic cardiomyopathy. Heart Rhythm 2019; 17:106-112. [PMID: 31229680 DOI: 10.1016/j.hrthm.2019.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND The efficacy of cascade screening for the inherited heart conditions long QT syndrome (LQTS) and hypertrophic cardiomyopathy (HCM) is incompletely characterized. OBJECTIVE The purpose of this study was to examine the use of genetic testing and yield of cascade screening across diverse regions in the United States and to evaluate obstacles to screening in multipayer systems. METHODS An institutional review board-approved 6 United States pediatric center retrospective chart review of LQTS and HCM patients from 2008-2014 was conducted for (1) genetic test completion and results and (2) family cascade screening acceptance, methods, results, and barriers. RESULTS The families of 315 index patients (mean age 9.0 ± 5.8 years) demonstrated a 75% (254) acceptance of cascade screening. The yield of relative screening was 39% (232/601), an average of 0.91 detected per family. Genetic testing was less utilized in HCM index patients and relatives. Screening participation was greater in families of gene-positive index patients (88%) (P <.001) compared to gene-negative patients (53%). Cascade method utilization: Cardiology-only 45%, combined genetic and cardiology 39%, and genetic only 16%. Screening yield by method: combined 57%, genetic-only 29%, and cardiology-only 20%. Family decisions were the leading barriers to cascade screening (26% lack of followthrough and 26% declined), whereas insurance (6%) was the least cited barrier. CONCLUSION Family participation in cascade screening is high, but the greatest barriers are family mediated (declined, lack of followthrough). Positive proband genetic testing led to greater participation. Cardiology-only screening was the most utilized method, but combined cardiology and genetic screening had the highest detection.
Collapse
Affiliation(s)
| | - Erin Miller
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua Kovach
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | | | | | - Lindsay Meyers
- University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah
| | - Curtis D Travers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Robert M Campbell
- Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Susan P Etheridge
- University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah
| |
Collapse
|
21
|
Heuvel L, Smets E, Tintelen J, Christiaans I. How to inform relatives at risk of hereditary diseases? A mixed‐methods systematic review on patient attitudes. J Genet Couns 2019; 28:1042-1058. [DOI: 10.1002/jgc4.1143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 12/21/2022]
Affiliation(s)
- L.M. Heuvel
- Department of Clinical Genetics Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
| | - E.M.A. Smets
- Department of Medical Psychology Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
| | - J.P. Tintelen
- Department of Genetics University Medical Centre Utrecht, University of Utrecht Utrecht The Netherlands
| | - I. Christiaans
- Department of Clinical Genetics Amsterdam University Medical Centres, University of Amsterdam Amsterdam The Netherlands
| |
Collapse
|
22
|
Informing relatives at risk of inherited cardiac conditions: experiences and attitudes of healthcare professionals and counselees. Eur J Hum Genet 2019; 27:1341-1350. [PMID: 31053782 DOI: 10.1038/s41431-019-0410-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/02/2019] [Accepted: 04/16/2019] [Indexed: 02/08/2023] Open
Abstract
Inherited cardiac conditions (ICCs) can lead to sudden cardiac death at young age, even without previous symptoms, yet often remain undetected. To prevent sudden cardiac death, cardiac monitoring and/or predictive DNA testing is advised for at-risk relatives. Probands in whom a causal variant is detected are asked to inform their relatives about the possibility of testing, often supported by a family letter. This qualitative study investigates experiences with and attitudes toward this family-mediated approach in ICCs and explores whether and how improvements can be made. Two online focus groups were conducted with 28 healthcare professionals (HCPs) from various disciplines, as were 25 face-to-face semi-structured interviews with counselees (10 probands; 15 relatives). Data were analysed by two researchers independently using a thematic approach. Participants, both HCPs and counselees, preferred that probands inform relatives about genetic risks in ICCs, but both groups struggled with the dependency on and burden on probands to inform their relatives. To overcome this, HCPs do see a more active role for themselves in informing relatives, but prefer uniformity in procedures in order to maintain their workload. Counselees, on the other hand, prefer a tailored information provision strategy adjusted to family dynamics and the personality characteristics of relatives. In conclusion, although it is generally preferred that probands inform relatives themselves, a more active role of HCPs could be considered to overcome the dependency and burden on probands. Further research is needed to study how HCPs can engage more actively in informing at-risk relatives in current clinical genetic practise.
Collapse
|
23
|
McVeigh TP, Kelly LJ, Whitmore E, Clark T, Mullaney B, Barton DE, Ward A, Lynch SA. Managing uncertainty in inherited cardiac pathologies-an international multidisciplinary survey. Eur J Hum Genet 2019; 27:1178-1185. [PMID: 30979968 DOI: 10.1038/s41431-019-0391-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/31/2019] [Accepted: 03/12/2019] [Indexed: 12/16/2022] Open
Abstract
Multi-gene testing is useful in genetically heterogeneous conditions, including inherited cardiac pathologies. Increasing the number of genes analysed increases diagnostic yield of variants of certain, likely, or uncertain pathogenicity. Concerns exist regarding management of variants of uncertain/likely pathogenicity in conditions of oligogenic inheritance or variable expressivity. We surveyed a sample of colleagues across different specialties and departments internationally to compare management of patients with class 3 or class 4 variants in genes associated with non-syndromic cardiomyopathy or arrhythmia. An electronic survey regarding clinical management of variants ( www.surveymonkey.com/r/cardiacvariants ) was designed and distributed to colleagues internationally via professional bodies and direct email. 150 respondents (88 centres, 27 countries) completed the survey, most of whom were Clinical Geneticists or Genetic Counsellors. Most respondents offer pre-symptomatic testing to asymptomatic relatives of an individual with class 4 or class 5 variants. A minority of respondents offer pre-symptomatic testing for class 3 variants. Considering class 4 variants, 22 (15%) are fully reassuring that the patient with a negative predictive test would not develop the familial phenotype, while 123 (82%) counselled patients about the possibility of variant reclassification. Variability existed between and within centres and specialties. Multiple "free text" comments were provided. Recurring themes including need for multidisciplinary input, technical concerns, and concern regarding duty to review variants of uncertain significance. This study demonstrates that variability in management of likely pathogenic/uncertain variants exists. Close multi-disciplinary input is essential. The development of disorder or gene-specific evidence-based guidelines might ameliorate uncertainty in management.
Collapse
Affiliation(s)
| | - Luke J Kelly
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth Whitmore
- The Children's University Hospital, Temple St, Dublin 1, Dublin, Ireland
| | - Tara Clark
- Our Lady's Children's Hospital Crumlin, Dublin 12, Dublin, Ireland
| | - Brendan Mullaney
- Our Lady's Children's Hospital Crumlin, Dublin 12, Dublin, Ireland
| | - David E Barton
- Our Lady's Children's Hospital Crumlin, Dublin 12, Dublin, Ireland
| | - Alana Ward
- Our Lady's Children's Hospital Crumlin, Dublin 12, Dublin, Ireland
| | - Sally Ann Lynch
- Our Lady's Children's Hospital Crumlin, Dublin 12, Dublin, Ireland.,The Children's University Hospital, Temple St, Dublin 1, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| |
Collapse
|
24
|
Burns C, Yeates L, Semsarian C, Ingles J. Evaluating a custom-designed aid to improve communication of genetic results in families with hypertrophic cardiomyopathy: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e026627. [PMID: 30782759 PMCID: PMC6361342 DOI: 10.1136/bmjopen-2018-026627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Genetic testing for hypertrophic cardiomyopathy (HCM) in the era of genomics brings unique challenges for genetic counselling. The number of genes routinely included in an HCM gene panel has increased markedly, many with minimal if any robust evidence of gene-disease association. Subsequently, there is a greater chance of uncertain genetic findings. The responsibility of communicating this information with at-risk relatives lies with the index case (proband). We have developed a communication aid to assist with the delivery of genetic results to the proband. We have previously shown the aid is feasible and acceptable and have now developed a study protocol for a randomised controlled trial of a genetic counsellor-led intervention incorporating the communication aid. METHODS AND ANALYSIS This is a prospective randomised controlled trial. We will investigate the impact of a genetic counsellor-led intervention to return proband genetic results using a custom-designed communication aid. We aim to improve knowledge and empowerment. The primary outcome of this trial is the ability and confidence of the proband to communicate genetic results to at-risk relatives. Secondary outcomes will assess genetic knowledge, satisfaction with services, outcomes from genetic counselling and psychological adaptation to genetic information. ETHICS AND DISSEMINATION This study has been approved by and is in strict accordance with the Sydney Local Health District Ethics Review Committee (X16-0030; 22/01/2016; version 1). Results from this trial will be prepared as a manuscript and submitted to peer-reviewed journals for publication as well as submission for presentation at national and international meetings. TRIAL REGISTRATION NUMBER ACTRN12617000706370.
Collapse
Affiliation(s)
- Charlotte Burns
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Laura Yeates
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
25
|
Shah LL, Daack-Hirsch S, Ersig AL, Paik A, Ahmad F, Williams J. Family Relationships Associated With Communication and Testing for Inherited Cardiac Conditions. West J Nurs Res 2018; 41:1576-1601. [PMID: 30539690 DOI: 10.1177/0193945918817039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to identify characteristics of family relationships associated with communication of genetic risk and testing behaviors among at-risk relatives in families with an inherited cardiac condition. Data were collected from 53 patients and parents of children with an inherited cardiac condition through interviews, pedigrees, and surveys. Associations were examined among family relationship characteristics and whether at-risk relatives were informed about their risk and tested for disease. Of 1,178 at-risk relatives, 52.5% were informed about their risk and 52.1% of those informed were tested. Emotional closeness, relationship quality, and communication frequency had significant bivariate associations with genetic risk communication. Communication frequency was associated with genetic risk communication and testing in multivariate models. This study provides new insight into the extent of genetic risk communication and testing in families with inherited cardiac conditions. Family relationships, especially communication frequency, are critical factors in family communication of genetic risk.
Collapse
|
26
|
Affiliation(s)
- B van Driel
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands.
| | - M Michels
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J van der Velden
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
27
|
Kinnamon DD, Morales A, Bowen DJ, Burke W, Hershberger RE. Toward Genetics-Driven Early Intervention in Dilated Cardiomyopathy: Design and Implementation of the DCM Precision Medicine Study. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.117.001826. [PMID: 29237686 DOI: 10.1161/circgenetics.117.001826] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The cause of idiopathic dilated cardiomyopathy (DCM) is unknown by definition, but its familial subtype is considered to have a genetic component. We hypothesize that most idiopathic DCM, whether familial or nonfamilial, has a genetic basis, in which case a genetics-driven approach to identifying at-risk family members for clinical screening and early intervention could reduce morbidity and mortality. METHODS On the basis of this hypothesis, we have launched the National Heart, Lung, and Blood Institute- and National Human Genome Research Institute-funded DCM Precision Medicine Study, which aims to enroll 1300 individuals (600 non-Hispanic African ancestry, 600 non-Hispanic European ancestry, and 100 Hispanic) who meet rigorous clinical criteria for idiopathic DCM along with 2600 of their relatives. Enrolled relatives will undergo clinical cardiovascular screening to identify asymptomatic disease, and all individuals with idiopathic DCM will undergo exome sequencing to identify relevant variants in genes previously implicated in DCM. Results will be returned by genetic counselors 12 to 14 months after enrollment. The data obtained will be used to describe the prevalence of familial DCM among idiopathic DCM cases and the genetic architecture of idiopathic DCM in multiple ethnicity-ancestry groups. We will also conduct a randomized controlled trial to test the effectiveness of Family Heart Talk, an intervention to aid family communication, for improving uptake of preventive screening and surveillance in at-risk first-degree relatives. CONCLUSIONS We anticipate that this study will demonstrate that idiopathic DCM has a genetic basis and guide best practices for a genetics-driven approach to early intervention in at-risk relatives. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT03037632.
Collapse
Affiliation(s)
- Daniel D Kinnamon
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.).
| | - Ana Morales
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.)
| | - Deborah J Bowen
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.)
| | - Wylie Burke
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.)
| | - Ray E Hershberger
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.).
| | | |
Collapse
|
28
|
Calcagnino M, Crocamo A, Ardissino D. Genetic testing in predicting the risk of sudden death. J Cardiovasc Med (Hagerstown) 2018; 18 Suppl 1:e64-e66. [PMID: 28009642 DOI: 10.2459/jcm.0000000000000477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
29
|
Bowen DJ, Hay JL, Harris-Wai JN, Meischke H, Burke W. All in the family? Communication of cancer survivors with their families. Fam Cancer 2018; 16:597-603. [PMID: 28374161 DOI: 10.1007/s10689-017-9987-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Families often bear the burden of communication about cancer risk, as well as support during and after treatment for cancer in family members. These activities are left up to survivors and their families, with little support or knowledge of useful methods. We present data on aspects of family that are most relevant to risk of cancer-related communication and health promotion among family members. Families (a survivor, one first-degree relative and one parent; n = 313 families) were enrolled in the survey-based study. We assessed multiple aspects of family communication about risk for melanoma among family participants. Families communicate less frequently than desired about cancer risk. Most families do identify a "family health provider" who keeps family data and serves a resource for family members. The reasons given for lack of family communication are diverse but many can be addressed as part of a family communication intervention. Families are poised to improve their family communication about cancer risk and so can play a role in increasing the health of their members.
Collapse
Affiliation(s)
- Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, P. O. Box 357120, Seattle, WA, 98195, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA
| | - Julie N Harris-Wai
- Department of Social and Behavioral Sciences, University of California San Francisco, 3333 California Street, San Francisco, CA, 94110, USA
| | - Hendrika Meischke
- Department of Health Services, University of Washington, Seattle, WA, 98105, USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, P. O. Box 357120, Seattle, WA, 98195, USA
| |
Collapse
|
30
|
Family Communication About Genetic Risk of Hereditary Cardiomyopathies and Arrhythmias: an Integrative Review. J Genet Couns 2018; 27:1022-1039. [PMID: 29492742 DOI: 10.1007/s10897-018-0225-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022]
Abstract
Screening for hereditary cardiomyopathies and arrhythmias (HCA) may enable early detection, treatment, targeted surveillance, and result in effective prevention of debilitating complications and sudden cardiac death. Screening at-risk family members for HCA is conducted through cascade screening. Only half of at-risk family members are screened for HCA. To participate in screening, at-risk family members must be aware of their risk. This often relies on communication from diagnosed individuals to their relatives. However, family communication is not well understood and is ripe for developing interventions to improve screening rates. Until very recently, family communication of genetic risk has been mostly studied in non-cardiac disease. Using this non-cardiac literature, we developed the family communication of genetic risk (FCGR) conceptual framework. The FCGR has four main elements of the communication process: influential factors, communication strategies, communication occurrence, and reaction to communication. Using the FCGR, we conducted an integrated review of the available literature on genetic risk communication in HCA families. Descriptive analysis of 12 articles resulted in the development of categories describing details of the FCGR elements in the context of HCA. This review synthesizes what is known about influential factors, communication strategies, communication occurrence, and outcomes of communication in the context of HCA.
Collapse
|
31
|
Lee TM, Hsu DT, Kantor P, Towbin JA, Ware SM, Colan SD, Chung WK, Jefferies JL, Rossano JW, Castleberry CD, Addonizio LJ, Lal AK, Lamour JM, Miller EM, Thrush PT, Czachor JD, Razoky H, Hill A, Lipshultz SE. Pediatric Cardiomyopathies. Circ Res 2017; 121:855-873. [PMID: 28912187 DOI: 10.1161/circresaha.116.309386] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pediatric cardiomyopathies are rare diseases with an annual incidence of 1.1 to 1.5 per 100 000. Dilated and hypertrophic cardiomyopathies are the most common; restrictive, noncompaction, and mixed cardiomyopathies occur infrequently; and arrhythmogenic right ventricular cardiomyopathy is rare. Pediatric cardiomyopathies can result from coronary artery abnormalities, tachyarrhythmias, exposure to infection or toxins, or secondary to other underlying disorders. Increasingly, the importance of genetic mutations in the pathogenesis of isolated or syndromic pediatric cardiomyopathies is becoming apparent. Pediatric cardiomyopathies often occur in the absence of comorbidities, such as atherosclerosis, hypertension, renal dysfunction, and diabetes mellitus; as a result, they offer insights into the primary pathogenesis of myocardial dysfunction. Large international registries have characterized the epidemiology, cause, and outcomes of pediatric cardiomyopathies. Although adult and pediatric cardiomyopathies have similar morphological and clinical manifestations, their outcomes differ significantly. Within 2 years of presentation, normalization of function occurs in 20% of children with dilated cardiomyopathy, and 40% die or undergo transplantation. Infants with hypertrophic cardiomyopathy have a 2-year mortality of 30%, whereas death is rare in older children. Sudden death is rare. Molecular evidence indicates that gene expression differs between adult and pediatric cardiomyopathies, suggesting that treatment response may differ as well. Clinical trials to support evidence-based treatments and the development of disease-specific therapies for pediatric cardiomyopathies are in their infancy. This compendium summarizes current knowledge of the genetic and molecular origins, clinical course, and outcomes of the most common phenotypic presentations of pediatric cardiomyopathies and highlights key areas where additional research is required. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT02549664 and NCT01912534.
Collapse
Affiliation(s)
- Teresa M Lee
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.).
| | - Daphne T Hsu
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Paul Kantor
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Jeffrey A Towbin
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Stephanie M Ware
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Steven D Colan
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Wendy K Chung
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - John L Jefferies
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Joseph W Rossano
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Chesney D Castleberry
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Linda J Addonizio
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Ashwin K Lal
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Jacqueline M Lamour
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Erin M Miller
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Philip T Thrush
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Jason D Czachor
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Hiedy Razoky
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Ashley Hill
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| | - Steven E Lipshultz
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (T.M.L., W.K.C., L.J.A.); Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY (D.T.H., J.M.L.); Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (P.K.); Department of Pediatrics, The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN (J.A.T.); Indiana University School of Medicine, Indianapolis (S.M.W.); Department of Cardiology, Boston Children's Hospital, MA (S.D.C.); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (J.L.J., E.M.M.); Department of Pediatrics, Children's Hospital of Philadelphia, PA (J.W.R.); Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.D.C.); Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT (A.K.L.); Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (P.T.T.); and Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit (J.D.C., H.R., A.H., S.E.L.)
| |
Collapse
|
32
|
Uptake of Predictive Genetic Testing and Cardiac Evaluation for Children at Risk for an Inherited Arrhythmia or Cardiomyopathy. J Genet Couns 2017; 27:124-130. [PMID: 28699125 DOI: 10.1007/s10897-017-0129-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 07/05/2017] [Indexed: 01/01/2023]
Abstract
Predictive genetic testing in minors should be considered when clinical intervention is available. Children who carry a pathogenic variant for an inherited arrhythmia or cardiomyopathy require regular cardiac screening and may be prescribed medication and/or be told to modify their physical activity. Medical genetics and pediatric cardiology charts were reviewed to identify factors associated with uptake of genetic testing and cardiac evaluation for children at risk for long QT syndrome, hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy. The data collected included genetic diagnosis, clinical symptoms in the carrier parent, number of children under 18 years of age, age of children, family history of sudden cardiac arrest/death, uptake of cardiac evaluation and if evaluated, phenotype for each child. We identified 97 at risk children from 58 families found to carry a pathogenic variant for one of these conditions. Sixty six percent of the families pursued genetic testing and 73% underwent cardiac screening when it was recommended. Declining predictive genetic testing was significantly associated with genetic specialist recommendation (p < 0.001) and having an asymptomatic carrier father (p = 0.006). Cardiac evaluation was significantly associated with uptake of genetic testing (p = 0.007). This study provides a greater understanding of factors associated with uptake of genetic testing and cardiac evaluation in children at risk of an inherited arrhythmia or cardiomyopathy. It also identifies a need to educate families about the importance of cardiac evaluation even in the absence of genetic testing.
Collapse
|
33
|
Genetic testing impacts the utility of prospective familial screening in hypertrophic cardiomyopathy through identification of a nonfamilial subgroup. Genet Med 2017. [DOI: 10.1038/gim.2017.79] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
34
|
Vermeer AMC, Janssen A, Boorsma PC, Mannens MMAM, Wilde AAM, Christiaans I. Transthyretin amyloidosis: a phenocopy of hypertrophic cardiomyopathy. Amyloid 2017; 24:87-91. [PMID: 28475415 DOI: 10.1080/13506129.2017.1322573] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disorder that affects over one in 500 persons worldwide. The autosomal dominant transmission of HCM implies that many relatives are at risk for HCM associated morbidity and mortality, therefore genetic testing and counselling is of great importance. However, in only 50-60% of the patients a mutation is found, which hampers predictive genetic testing in relatives. In HCM patients in whom the causal mutation has not been identified (yet), phenocopies of HCM - i.e. diseases that mimic HCM - could be responsible for the HCM phenotype. One of the HCM phenocopies is transthyretin amyloidosis (ATTR), caused by mutations in the transthyretin (TTR) gene. METHODS From 697 HCM index patients referred to our cardiogenetics outpatient clinic and tested for HCM associated genes between January 1997 and December 2012, we selected the ones without a detected causal mutation (n = 345). In these patients, additional DNA analysis of the TTR gene was performed. RESULTS In four patients (1.2%), a TTR mutation was detected (E7G, V30M, T119M, V122I). The E7G mutation is probably a non-pathogenic mutation. The T119M mutation is a known TTR mutation, but does not cause a cardiac phenotype. So in two (0.6%) patients, TTR analysis identified the cause of their HCM. CONCLUSIONS ATTR should always be considered in patients with unexplained HCM, especially because of the great benefit of an early diagnosis regarding treatment and prognosis.
Collapse
Affiliation(s)
- Alexa M C Vermeer
- a Department of Clinical Genetics , Academic Medical Center , Amsterdam , The Netherlands.,b Department of Clinical and Experimental Cardiology, Heart Center , Academic Medical Center , Amsterdam , The Netherlands
| | - Anneloes Janssen
- a Department of Clinical Genetics , Academic Medical Center , Amsterdam , The Netherlands
| | - Peter C Boorsma
- a Department of Clinical Genetics , Academic Medical Center , Amsterdam , The Netherlands
| | - Marcel M A M Mannens
- a Department of Clinical Genetics , Academic Medical Center , Amsterdam , The Netherlands
| | - Arthur A M Wilde
- b Department of Clinical and Experimental Cardiology, Heart Center , Academic Medical Center , Amsterdam , The Netherlands.,c Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University , Jeddah , Kingdom of Saudi Arabia
| | - Imke Christiaans
- a Department of Clinical Genetics , Academic Medical Center , Amsterdam , The Netherlands
| |
Collapse
|
35
|
Motivation, Perception, and Treatment Beliefs in the Myocardial Infarction Genes (MI-GENES) Randomized Clinical Trial. J Genet Couns 2017; 26:1153-1161. [DOI: 10.1007/s10897-017-0092-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
|
36
|
Souzeau E, Tram KH, Witney M, Ruddle JB, Graham SL, Healey PR, Goldberg I, Mackey DA, Hewitt AW, Burdon KP, Craig JE. Myocilin Predictive Genetic Testing for Primary Open-Angle Glaucoma Leads to Early Identification of At-Risk Individuals. Ophthalmology 2017; 124:303-309. [DOI: 10.1016/j.ophtha.2016.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/23/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022] Open
|
37
|
Sturm AC. Cardiovascular Cascade Genetic Testing: Exploring the Role of Direct Contact and Technology. Front Cardiovasc Med 2016; 3:11. [PMID: 27148542 PMCID: PMC4835441 DOI: 10.3389/fcvm.2016.00011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/05/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Amy C Sturm
- Department of Internal Medicine, Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH, USA; Ohio State University Wexner Medical Center, Dorothy M. Davis Heart and Lung Research Institute, Columbus, OH, USA
| |
Collapse
|
38
|
Burns C, McGaughran J, Davis A, Semsarian C, Ingles J. Factors influencing uptake of familial long QT syndrome genetic testing. Am J Med Genet A 2015; 170A:418-425. [PMID: 26544151 DOI: 10.1002/ajmg.a.37455] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 10/15/2015] [Indexed: 12/21/2022]
Abstract
Ongoing challenges of clinical assessment of long QT syndrome (LQTS) highlight the importance of genetic testing in the diagnosis of asymptomatic at-risk family members. Effective access, uptake, and communication of genetic testing are critical for comprehensive cascade family screening and prevention of disease complications such as sudden cardiac death. The aim of this study was to describe factors influencing uptake of LQTS genetic testing, including those relating to access and family communication. We show those who access genetic testing are overrepresented by the socioeconomically advantaged, and that although overall family communication is good, there are some important barriers to be addressed. There were 75 participants (aged 18 years or more, with a clinical and/or genetic diagnosis of LQTS; response rate 71%) who completed a survey including a number of validated scales; demographics; and questions about access, uptake, and communication. Mean age of participants was 46 ± 16 years, 20 (27%) were males and 60 (80%) had genetic testing with a causative gene mutation in 42 (70%). Overall uptake of cascade testing within families was 60% after 4 years from proband genetic diagnosis. All participants reported at least one first-degree relative had been informed of their risk, whereas six (10%) reported at least one first-degree relative had not been informed. Those who were anxious or depressed were more likely to perceive barriers to communicating. Genetic testing is a key aspect of care in LQTS families and intervention strategies that aim to improve equity in access and facilitate effective family communication are needed.
Collapse
Affiliation(s)
- Charlotte Burns
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Julie McGaughran
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Davis
- Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
39
|
Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
40
|
Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36:2793-2867. [PMID: 26320108 DOI: 10.1093/eurheartj/ehv316] [Citation(s) in RCA: 2530] [Impact Index Per Article: 281.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Acute Disease
- Aged
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/therapy
- Autopsy/methods
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathies/complications
- Cardiomyopathies/therapy
- Cardiotonic Agents/therapeutic use
- Catheter Ablation/methods
- Child
- Coronary Artery Disease/complications
- Coronary Artery Disease/therapy
- Death, Sudden, Cardiac/prevention & control
- Defibrillators
- Drug Therapy, Combination
- Early Diagnosis
- Emergency Treatment/methods
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Heart Transplantation/methods
- Heart Valve Diseases/complications
- Heart Valve Diseases/therapy
- Humans
- Mental Disorders/complications
- Myocardial Infarction/complications
- Myocardial Infarction/therapy
- Myocarditis/complications
- Myocarditis/therapy
- Nervous System Diseases/complications
- Nervous System Diseases/therapy
- Out-of-Hospital Cardiac Arrest/therapy
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Primary Prevention/methods
- Quality of Life
- Risk Assessment
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Sports/physiology
- Stroke Volume/physiology
- Terminal Care/methods
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/therapy
Collapse
|
41
|
Jensen MK, Havndrup O, Christiansen M, Andersen PS, Axelsson A, Køber L, Bundgaard H. Echocardiographic evaluation of pre-diagnostic development in young relatives genetically predisposed to hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2015; 31:1511-8. [PMID: 26231341 DOI: 10.1007/s10554-015-0723-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/25/2015] [Indexed: 11/29/2022]
Abstract
Identification of the first echocardiographic manifestations of hypertrophic cardiomyopathy may be important for clinical management and our understanding of the pathogenesis. We studied the development of pre-diagnostic echocardiographic changes in young relatives to HCM patients during long-term years follow-up. HCM-relatives not fulfilling the diagnostic criteria for HCM and age of <18 years were included in this study. We performed echocardiographic evaluations at inclusion and after 12 ± 1 years follow-up. Based on family screening of 11 sarcomere genes, CRYAB, α-GAL, and titin, we evaluated: (1) non-carriers (known family mutation ruled out-controls), (2) carriers (phenotype negative gene mutation carriers) and (3) phenotype negative relatives with unknown genetic status (relatives from families without identified mutations). At inclusion (age 11 ± 5 years), there were no differences in echocardiographic chamber dimensions, systolic or diastolic function between the three groups. During follow-up (age 23 ± 5 years), carriers (n = 8) developed lower left ventricular end-diastolic dimension (LVEDd) compared to non-carriers (n = 23) (41 ± 4 vs. 46 ± 4 mm; p = 0.04) and a higher ratio of early left ventricular filling velocity and early diastolic velocity of lateral mitral annulus (E/e' 6 ± 1 vs. 5 ± 1; p = 0.003). No significant differences in LVEDd or E/e' were found between relatives with unknown genetic status (n = 24) and non-carriers though Z-scores for these parameters were >2 in a subset of relatives with unknown genetic status. Children carrying pathogenic sarcomere gene mutations develop reduced LVEDd and increased E/e' as first pre-diagnostic echocardiographic manifestations during follow-up into adulthood.
Collapse
Affiliation(s)
- Morten K Jensen
- The Unit for Inherited Heart Diseases, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Ole Havndrup
- Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark
| | - Michael Christiansen
- Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark
| | - Paal S Andersen
- Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark
| | - Anna Axelsson
- The Unit for Inherited Heart Diseases, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Køber
- The Unit for Inherited Heart Diseases, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Henning Bundgaard
- The Unit for Inherited Heart Diseases, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| |
Collapse
|
42
|
Lee TM, Ware SM. Toward Personalized Medicine: Does Genetic Diagnosis of Pediatric Cardiomyopathy Influence Patient Management? PROGRESS IN PEDIATRIC CARDIOLOGY 2015; 39:43-47. [PMID: 26380543 DOI: 10.1016/j.ppedcard.2015.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A goal of personalized medicine is to provide increasingly sophisticated, individualized approaches to management and therapy for disease. Genetics is the engine that drives personalized medicine, holding the promise of therapeutics directed toward the unique needs of each patient. The 3rd International Conference on Cardiomyopathy in Children provided a forum to discuss the current status of personalized approaches to diagnosis, management, and therapy in the pediatric cardiomyopathy population. This review will focus on the importance of genetic diagnosis in this population as a necessary first step toward understanding the best approach to management and influencing disease outcome. The genetic heterogeneity of cardiomyopathy in children, the implications of specific genotypes, the ability to risk stratify based on genotype, and the impact on cascade screening in family members will be discussed.
Collapse
Affiliation(s)
- Teresa M Lee
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY 10032
| | - Stephanie M Ware
- Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202
| |
Collapse
|
43
|
Hein IM, Troost PW, Lindeboom R, Christiaans I, Grisso T, van Goudoever JB, Lindauer RJL. Feasibility of an Assessment Tool for Children's Competence to Consent to Predictive Genetic Testing: a Pilot Study. J Genet Couns 2015; 24:971-7. [PMID: 25911621 PMCID: PMC4643102 DOI: 10.1007/s10897-015-9835-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/19/2015] [Indexed: 01/13/2023]
Abstract
Knowledge on children’s capacities to consent to medical treatment is limited. Also, age limits for asking children’s consent vary considerably between countries. Decision-making on predictive genetic testing (PGT) is especially complicated, considering the ongoing ethical debate. In order to examine just age limits for alleged competence to consent in children, we evaluated feasibility of a standardized assessment tool, and investigated cutoff ages for children’s competence to consent to PGT. We performed a pilot study, including 17 pediatric outpatients between 6 and 18 years at risk for an autosomal dominantly inherited cardiac disease, eligible for predictive genetic testing. The reference standard for competence was established by experts trained in the relevant criteria for competent decision-making. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) served as index test. Data analysis included raw agreement between competence classifications, difference in mean ages between children judged competent and judged incompetent, and estimation of cutoff ages for judgments of competence. Twelve (71 %) children were considered competent by the reference standard, and 16 (94 %) by the MacCAT-T, with an overall agreement of 76 %. The expert judgments disagreed in most cases, while the MacCAT-T judgments agreed in 65 %. Mean age of children judged incompetent was 9.3 years and of children judged competent 12.1 years (p = .035). With 90 % sensitivity, children younger than 10.0 years were judged incompetent, with 90 % specificity children older than 11.8 years were judged competent. Feasibility of the MacCAT-T in children is confirmed. Initial findings on age cutoffs are indicative for children between the age of 12 and 18 to be judged competent for involvement in the informed consent process. Future research on appropriate age-limits for children’s alleged competence to consent is needed.
Collapse
Affiliation(s)
- Irma M Hein
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - Pieter W Troost
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Robert Lindeboom
- Department of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Imke Christiaans
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Thomas Grisso
- Department of Psychology, Law and Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, and Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
44
|
Khouzam A, Kwan A, Baxter S, Bernstein JA. Factors Associated with Uptake of Genetics Services for Hypertrophic Cardiomyopathy. J Genet Couns 2015; 24:797-809. [PMID: 25566741 DOI: 10.1007/s10897-014-9810-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/12/2014] [Indexed: 12/22/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a common cardiovascular disorder with variable expressivity and incomplete penetrance. Clinical guidelines recommend consultation with a genetics professional as part of an initial assessment for HCM, yet there remains an underutilization of genetics services. We conducted a study to assess factors associated with this underutilization within the framework of the Health Belief Model (HBM). An online survey was completed by 306 affected individuals and at risk family members. Thirty-seven percent of individuals (113/306) had visited a genetics professional for reasons related to HCM. Genetic testing was performed on 53 % (162/306). Individuals who had undergone testing were more likely to have seen a genetics professional (p < 0.001), had relatives with an HCM diagnosis (p = 0.002), and have a known familial mutation (p < 0.001). They were also more likely to agree that genetic testing would satisfy their curiosity (p < 0.001), provide reassurance (p < 0.001), aid family members in making healthcare decisions (p < 0.001), and encourage them to engage in a healthier lifestyle (p = 0.002). The HBM components of cues to action and perceived benefits and barriers had the greatest impact on uptake of genetic testing. In order to ensure optimal counseling and care for individuals and families with HCM, awareness and education around HCM and genetic services should be promoted in both physicians and patients alike.
Collapse
Affiliation(s)
- Amirah Khouzam
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Andrea Kwan
- Department of Genetics, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Division of Medical Genetics, Stanford University, 300 Pasteur Dr. H-315, Stanford, CA, 94305, USA
| | - Samantha Baxter
- Laboratory for Molecular Medicine, Partners HealthCare Center for Personalized Genetic Medicine, Cambridge, MA, USA
| | - Jonathan A Bernstein
- Department of Pediatrics, Division of Medical Genetics, Stanford University, 300 Pasteur Dr. H-315, Stanford, CA, 94305, USA.
| |
Collapse
|
45
|
Tariq M, Ware SM. Importance of genetic evaluation and testing in pediatric cardiomyopathy. World J Cardiol 2014; 6:1156-1165. [PMID: 25429328 PMCID: PMC4244613 DOI: 10.4330/wjc.v6.i11.1156] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/29/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Pediatric cardiomyopathies are clinically heterogeneous heart muscle disorders that are responsible for significant morbidity and mortality. Phenotypes include hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, left ventricular noncompaction and arrhythmogenic right ventricular cardiomyopathy. There is substantial evidence for a genetic contribution to pediatric cardiomyopathy. To date, more than 100 genes have been implicated in cardiomyopathy, but comprehensive genetic diagnosis has been problematic because of the large number of genes, the private nature of mutations, and difficulties in interpreting novel rare variants. This review will focus on current knowledge on the genetic etiologies of pediatric cardiomyopathy and their diagnostic relevance in clinical settings. Recent developments in sequencing technologies are greatly impacting the pace of gene discovery and clinical diagnosis. Understanding the genetic basis for pediatric cardiomyopathy and establishing genotype-phenotype correlations may help delineate the molecular and cellular events necessary to identify potential novel therapeutic targets for heart muscle dysfunction in children.
Collapse
|
46
|
Batte B, Sheldon JP, Arscott P, Huismann DJ, Salberg L, Day SM, Yashar BM. Family communication in a population at risk for hypertrophic cardiomyopathy. J Genet Couns 2014; 24:336-48. [PMID: 25304619 DOI: 10.1007/s10897-014-9774-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/09/2014] [Indexed: 01/11/2023]
Abstract
Encouraging family communication is an integral component of genetic counseling; therefore, we sought to identify factors impacting communication to family members at risk for Hypertrophic Cardiomyopathy (HCM). Participants (N = 383) completed an online survey assessing: 1) demographics (gender, genetic test results, HCM family history, and disease severity); 2) illness representations; 3) family functioning and cohesiveness; 4) coping styles; 5) comprehension of HCM autosomal dominant inheritance; and 6) communication of HCM risk information to at-risk relatives. Participants were a national sample of individuals with HCM, recruited through the Hypertrophic Cardiomyopathy Association. Data from 183 participants were analyzed using a logistic regression analysis, with family communication as a dichotomous dependent variable. We found that female gender and higher comprehension of autosomal dominant inheritance were significant predictors of participants' communication of HCM risk information to all their siblings and children. Our results suggest that utilizing interventions that promote patient comprehension (e.g., a teaching-focused model of genetic counseling) are important and may positively impact family communication within families with HCM.
Collapse
Affiliation(s)
- Brittany Batte
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA,
| | | | | | | | | | | | | |
Collapse
|
47
|
Making the Decision to Participate in Predictive Genetic Testing for Arrhythmogenic Right Ventricular Cardiomyopathy. J Genet Couns 2014; 23:1045-55. [DOI: 10.1007/s10897-014-9733-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
|
48
|
Menko FH, Aalfs CM, Henneman L, Stol Y, Wijdenes M, Otten E, Ploegmakers MMJ, Legemaate J, Smets EMA, de Wert GMWR, Tibben A. Informing family members of individuals with Lynch syndrome: a guideline for clinical geneticists. Fam Cancer 2014; 12:319-24. [PMID: 23535968 DOI: 10.1007/s10689-013-9636-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The diagnosis of Lynch syndrome can lead to the prevention of colorectal cancer through periodic colonoscopies and removal of premalignant lesions in susceptible individuals. Therefore, predisposed individuals identified by mutation analysis are advised to inform their at-risk relatives about the options of predictive DNA testing and preventive measures. However, it has now been established that more than half of these relatives do not receive the necessary information. Barriers in conveying information include family communication problems and variable attitudes and practice among clinical geneticists. In this complex field, both medical, psychological, ethical and juridical aspects deserve consideration. Here we summarize the development of a revised guideline for clinical geneticists that allows a more active role of the geneticist, aimed at improving procedures to inform family members in Lynch syndrome and other hereditary and familial cancer syndromes.
Collapse
Affiliation(s)
- Fred H Menko
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
50
|
Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C. Executive Summary: HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
|