Educational outreach via direct messaging may improve FH screening, diagnosis
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Messaging built into an existing electronic health records system to directly connect physicians may increase screening and diagnosis of familial hypercholesterolemia among patients identified as being high risk, a speaker reported.
“Familial hypercholesterolemia is an autosomal dominant disorder, and it involves the LDL-C uptake in metabolism and [FH] occurs in 1 out of 200 to 250 individuals,” Loba Alam, MD, who was an internal medicine resident under the direction of Robert Fishberg, MD, at Atlantic Health System New Jersey during the conduct of the study, now an advanced cardiac imaging fellow at the Icahn School of Medicine at Mount Sinai Morningside and winner of the 2021 Donald Hunninghake Familial Hypercholesterolemia abstract award, said during the presentation at the National Lipid Association Scientific Sessions.
According to the study, approximately 5% of all MIs in the U.S. are caused by FH; however, only 10% of MIs caused by FH have been identified. If untreated, men with FH have a 50% chance of experiencing an MI by 50 years of age, while women have a 30% chance by 60 years of age.
“However, if you were to treat these patients with aggressive medical treatment, it would reduce their odds of having an MI to that of not having FH,” Alam said.
The underdiagnosis of FH represents a large, unmet burden on both patients and the health care system, according to the study.
“There are many barriers to diagnosing familial hypercholesterolemia and they include financial, social and legal considerations,” Alam said during the presentation. “One of the barriers that we found was the lack of general awareness among primary care physicians to be able to recognize FH.”
In 2019, the researchers used the Epic electronic health record system to send “Epic Letters” to primary care physicians with the goal of increasing awareness about FH but were met with a low response rate (6.5%) and ineffective follow-up screening.
For this study, researchers used the secure Epic Chat to directly text message members of the patients’ care team, namely their primary care physicians, in an effort to improve screening for FH. Researchers identified approximately 1,000 patients in the Atlantic Health System’s national Cascade FH registry with LDL greater than 160 mg/dL and selected 200 with possible or probable FH. Researchers then contacted each patient’s primary care physician via Epic Chat using the same letter from the 2019 study.
Alam and colleagues hypothesized that, because Epic Chat is a part of the health care workflow, they would get more immediate responses from primary care physicians and increase effectiveness of FH diagnosis.
According to the study, educational outreach via Epic Chat generated a 28% response rate among the primary care physicians compared with the 6.5% response rate generated by Epic Letter.
Researchers noted a robust response among physicians, observing immediate dialogue with patients with possible or probable FH.
According to the study, the youngest patient screened and subsequently diagnosed with FH was a 26-year-old woman, whose parents were also subsequently screened, and the patient’s father was also identified as a FH carrier. Neither had developed a CVD as of the time of screening, and both started on appropriate lipid management.
“With these follow-up patients and their families that we were able to identify with FH cascade screening, we hope to follow them in subsequent clinic visits and continue them on aggressive lipid management and lifestyle modifications,” Alam said. “We believe that primary care physicians are at an advantage of identifying familial hypercholesterolemia at an early age and we hope that this initiative will inspire and increase awareness for identifying and treating FH across all of our health care systems.”
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Alam L. 2021 Donald Hunninghake Familial Hypercholesterolemia Abstract Award. Presented at: National Lipid Association Scientific Sessions; Sept. 24-26, 2021; Orlando, Fla. (hybrid meeting).
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