1
|
Hadfield SG, Horara S, Starr BJ, Yazdgerdi S, Marks D, Bhatnagar D, Cramb R, Egan S, Everdell R, Ferns G, Jones A, Marenah CB, Marples J, Prinsloo P, Sneyd A, Stewart MF, Sandle L, Wang T, Watson MS, Humphries SE. Family tracing to identify patients with familial hypercholesterolaemia: the second audit of the Department of Health Familial Hypercholesterolaemia Cascade Testing Project. Ann Clin Biochem 2008; 46:24-32. [PMID: 19028807 DOI: 10.1258/acb.2008.008094] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Family tracing is a method recognized to find new patients with familial hypercholesterolaemia (FH). We have implemented family tracing led by FH Nurses and have determined acceptability to patients, feasibility and costs. METHODS Nurses were located at five National Health Service (NHS) Trusts; they identified FH patients and offered them family tracing. Responses and test results were recorded on a database and summarized on a family pedigree. RESULTS The majority ( approximately 70%) of index cases participated; the proportion was lower when patients had been discharged from the clinics and in metropolitan areas. On average, 34% (range 13-50%) of relatives lived outside the catchment area of the clinics and could not attend the nurse-led FH clinics. Of the previously untested relatives, 76% who lived in the catchment area of the clinic came forward to be tested. One-third of the relatives who came forward for testing were children <or=16 y of age. The proportion of relatives diagnosed as likely to have FH was lower than would be predicted (30% vs. 50%). This was mainly due to the uncertainty of a diagnosis based on lipid measurements. The average cost to identify and test one relative was approximately pound 500 but was higher in the metropolitan areas. CONCLUSION Cascade testing for FH in the UK is feasible, acceptable and likely to be cost-effective if it is a routine aspect of clinical care. However, national implementation would require an integrated infrastructure, so that all individuals have access to testing, and specialist services for the management of young people.
Collapse
Affiliation(s)
- S G Hadfield
- Institute of Child Health, London IDEAS Genetics Knowledge Park, UCL, 30 Guilford Street, London WC1N 1EH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Hadfield SG, Horara S, Starr BJ, Yazdgerdi S, Bhatnagar D, Cramb R, Egan S, Everdell R, Ferns G, Jones A, Marenah CB, Marples J, Prinsloo P, Sneyd A, Stewart MF, Sandle L, Wang T, Watson MS, Humphries SE. Are patients with familial hypercholesterolaemia well managed in lipid clinics? An audit of eleven clinics from the Department of Health Familial Hypercholesterolaemia Cascade Testing project. Ann Clin Biochem 2008; 45:199-205. [DOI: 10.1258/acb.2007.007078] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Familial hypercholesterolaemia (FH) is an autosomal co-dominant disorder which is relatively common, leads to high levels of LDL-cholesterol and if untreated to early coronary heart disease. An audit of current practice at National Health Service Trusts in England was undertaken to determine whether FH patients meet the diagnostic criteria for FH; are being offered appropriate advice and treatment; and to what extent their families are contacted and offered testing for the disorder. Methods Medical records of known FH patients (over 18 years of age and diagnosed before 31 December 2003) were accessed to obtain information on diagnosis, treatment and family tracing. Results The records of 733 FH patients were examined, 79% met the UK ‘Simon Broome’ register criteria for the diagnosis of definite or possible FH. Analyses showed that patients were usually offered appropriate advice and treatment, with 89% being on a statin. However, the audit indicated a high variability in family tracing between the sites, with significant differences in the frequency of inclusion of a family pedigree in the notes (range 1–71%, mean 35%); the general practitioner (GP) being advised that first-degree relatives should be tested (range 4–52%, mean 27%); and the proportion of relatives contacted and tested (range 6–50%, mean 32%). Conclusion FH patients are well cared for in lipid clinics in England, are being given appropriate lifestyle advice and medication, but an increase in recording of LDL-cholesterol levels may lead to improvements in their management. Practice in family tracing appears to vary widely between clinics.
Collapse
Affiliation(s)
- S G Hadfield
- London IDEAS Genetics Knowledge Park, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - S Horara
- London IDEAS Genetics Knowledge Park, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - B J Starr
- London IDEAS Genetics Knowledge Park, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - S Yazdgerdi
- London IDEAS Genetics Knowledge Park, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - D Bhatnagar
- The Royal Oldham Hospital, The Pennine Acute Hospitals NHS Trust, Rochdale Road, Oldham OL1 2JH, UK
| | - R Cramb
- The Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham B15 2TH, UK
| | - S Egan
- Royal Bournemouth Hospital, The Royal Bournemouth & Christchurch Hospitals NHS Trust, Castle Lane East, Bournemouth BH7 7DW, UK
| | - R Everdell
- Royal Bournemouth Hospital, The Royal Bournemouth & Christchurch Hospitals NHS Trust, Castle Lane East, Bournemouth BH7 7DW, UK
| | - G Ferns
- Royal Surrey County Hospital, Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - A Jones
- Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
| | - C B Marenah
- Nottingham University Hospitals NHS Trust, City Campus, Hucknall Road, Nottingham NG5 1PB, UK
| | - J Marples
- Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Trust, Wigan Lane, Wigan WN1 2NN, UK
| | - P Prinsloo
- Nottingham University Hospitals NHS Trust, City Campus, Hucknall Road, Nottingham NG5 1PB, UK
| | - A Sneyd
- Nottingham University Hospitals NHS Trust, City Campus, Hucknall Road, Nottingham NG5 1PB, UK
| | - M F Stewart
- Hope Hospital, Salford Royal Hospitals NHS Trust, Stott Lane, Salford M6 8HD, UK
| | - L Sandle
- Trafford General Hospital, Trafford Healthcare NHS Trust, Moorside Road, Davyhulme, Manchester M41 5SL, UK
| | - T Wang
- Royal Surrey County Hospital, Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, Surrey GU2 7XX, UK
- Frimley Park Hospital NHS Foundation Trust, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK
| | - M S Watson
- Royal Surrey County Hospital, Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - S E Humphries
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, The Rayne Building, Royal Free and University College London Medical School, London WC1E 6JJ, UK
| |
Collapse
|