Effect of Adding Systematic Family History Enquiry to Cardiovascular Disease Risk Assessment in Primary Care
Effect of Adding Systematic Family History Enquiry to Cardiovascular Disease Risk Assessment in Primary Care
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DOI：
10.7326/0003-4819-156-4-201202210-00002
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发表时间：
2012-02-21
影响因子：
39.2
通讯作者：
Kai, Joe
中科院分区：
文献类型：
--
作者：
Qureshi, Nadeem;Armstrong, Sarah;Kai, Joe
背景：在初级保健中系统收集冠心病家族史价值的证据有限。目的：评估在初级保健中系统收集冠心病家族史的可行性以及将这些数据纳入心血管风险评估的效果。设计：务实、配对、整群随机、对照试验。 （国际标准化随机对照试验编号登记号：ISRCTN 17943542）。地点：英国 24 个家庭诊所。参与者：2007 年 7 月至 2009 年 3 月间观察到的 748 名年龄在 30 至 65 岁之间、之前没有诊断出心血管风险的人。干预：对照实践中的参与者在使用或不使用病历中现有家族史信息的情况下进行了通常的基于弗雷明汉的心血管风险评估。干预实践的参与者还完成了一份调查问卷，以系统地收集他们的家族史。所有参与者都被告知他们的风险状况。邀请具有高心血管风险的参与者进行咨询。测量：主要结果是具有高心血管风险的参与者的比例（10年风险> = 20%）。其他衡量指标包括问卷完成率和焦虑评分。结果：98% 的参与者完成了家族史问卷。在干预实践中，被归类为心血管高风险的参与者比例平均增加了 4.8 个百分点，而在纳入患者记录家族史的对照实践中，这一比例平均增加了 0.3 个百分点。调整参与者和实践特征后，组间 4.5 个百分点的差异（95% CI，1.7 至 7.2 个百分点）仍然显着（P = 0.007）。各组之间的焦虑评分相似。 局限性：来自少数民族或受教育程度较低群体的参与者相对较少。探索行为改变和临床结果的潜力是有限的。焦虑评分缺少许多数据。结论：系统地收集家族史可以增加被确定为具有高心血管风险的人的比例，以便进一步进行有针对性的预防，但似乎对焦虑影响很小或没有影响。
Background: Evidence of the value of systematically collecting family history in primary care is limited.Objective: To evaluate the feasibility of systematically collecting family history of coronary heart disease in primary care and the effect of incorporating these data into cardiovascular risk assessment.Design: Pragmatic, matched-pair, cluster randomized, controlled trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN 17943542).Setting: 24 family practices in the United Kingdom.Participants: 748 persons aged 30 to 65 years with no previously diagnosed cardiovascular risk, seen between July 2007 and March 2009.Intervention: Participants in control practices had the usual Framingham-based cardiovascular risk assessment with and without use of existing family history information in their medical records. Participants in intervention practices also completed a questionnaire to systematically collect their family history. All participants were informed of their risk status. Participants with high cardiovascular risk were invited for a consultation.Measurements: The primary outcome was the proportion of participants with high cardiovascular risk (10-year risk >= 20%). Other measures included questionnaire completion rate and anxiety score.Results: 98% of participants completed the family history questionnaire. The mean increase in proportion of participants classified as having high cardiovascular risk was 4.8 percentage points in the intervention practices, compared with 0.3 percentage point in control practices when family history from patient records was incorporated. The 4.5-percentage point difference between groups (95% CI, 1.7 to 7.2 percentage points) remained significant after adjustment for participant and practice characteristics (P = 0.007). Anxiety scores were similar between groups.Limitations: Relatively few participants were from ethnic minority or less-educated groups. The potential to explore behavioral change and clinical outcomes was limited. Many data were missing for anxiety scores.Conclusion: Systematically collecting family history increases the proportion of persons identified as having high cardiovascular risk for further targeted prevention and seems to have little or no effect on anxiety.