More work needed to increase FH awareness, knowledge
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ATLANTA — Some progress has been made in increasing the knowledge and awareness of FH among general practitioners, cardiologists and other specialists, although more needs to be done to increase these efforts, according to a presentation at the FH Foundation’s FH Global Summit.
FH is not only a health concern in the U.S., but also a global health concern, Rodrigo Alonso Karlezi, MD, PhD, specialist in internal medicine at Universidad Autónoma de Madrid, said during the presentation. Although many countries have consensus statements with regards to this condition, many are not screening for and taking care of patients with FH, he said.
“We don’t have data about the awareness and knowledge of FH among physicians,” Karlezi said.
There was a meeting of the Americas, Spain and Portugal to determine how best to assess awareness, knowledge and perception of FH among treating physicians. A survey was then conducted to collect these data. From there, the survey was translated to Spanish, French and Portuguese and distributed through SurveyMonkey. Although the target population was originally general practitioners, other specialists were identified such as lipidologists and endocrinologists, Karlezi said.
There were 1,036 surveys that were completed and assessed, most of which came from the U.S.
Two questions focused on awareness. There were 56% of physicians who considered themselves familiar with FH, which ranged from 37% in Columbia and Chile to 78% in Spain and Portugal.
Variation in familiarity
“It looks like countries with nationwide or regional screening programs, guidelines or strategies for FH, having been working a long time in FH or doing a lot of research have a higher familiarity with FH than the other countries,” Karlezi said.
Similar results were seen with regards to awareness of diagnostic criteria of FH, with 82% in Spain and Portugal.
Knowledge of the prevalence of FH — one in 250 patients — was low, with an average of 22% in all of the countries who completed the survey. This knowledge was reported by 56% of participants in Spain and 46% of participants in Canada. The knowledge of the prevalence of FH as one in 500 patients was also low.
“We’re always repeating FH is not a rare disease; FH is a common disease, but the understanding is very low,” Karlezi said during the presentation.
Perception of high risk
The CV risk associated with FH — 20 times the risk in patients with FH compared with the general population — was understood by 16% of physicians. When CV risk was defined as 10 times to 20 times, the rate of understanding was 44%.
“The perception of high risk is not so fixed in these physicians,” Karlezi said during the presentation.
When asked when to test young patients for FH with premature CAD in the family, 21% of physicians said they would screen patients younger than 6 years of age, 30% said between 7 and 12 years and 32% said during late adolescence.
When specialists were assessed, the greatest awareness of FH was reported by lipidologists, although 47% of general practitioners were aware of diagnostic criteria.
“We consider that GPs and primary care are essential for the screening strategies we need to increase this number,” Karlezi said during the presentation.
One in four physicians understood the importance of the use of genetic testing to diagnose FH. Cascade screening is the most cost-effective strategy to detect new cases of FH, although 52% of physicians perform this in children across relatives, Karlezi said. There were 17% of general practitioners and 6% of cardiologists who do not perform cascade screening.
With regards of when to test children with premature CAD in the family, 22% of physicians, regardless of specialty, would test before 6 years of age and 42% of general practitioners would test children after 13 years of age.
“Knowledge of FH recommendations, their implementation and application are essential for the treatment and prevention of cardiovascular disease in this population,” Karlezi said during the presentation. “Also, we have to introduce GPs to all recommendations. They have to be involved in the implementation of specific guidelines in the country.” – by Darlene Dobkowski
Reference:
Karlezi RA. New Data: Primary Care Knowledge in the Americas. Presented at: The FH Foundation’s FH Global Summit; Oct. 20-21, 2019; Atlanta.
Disclosures: The study was supported through research grants from Amgen and Sanofi/Regeneron. Cardiology Today could not confirm relevant financial disclosures for Karlezi at the time of publication.