February 21st, 2012

More Rigorous Assessment of Family History Improves CV Risk Determination

Although family history has long been recognized as an important cardiovascular risk factor, usual methods to assess risk have not incorporated family history in a rigorous manner. A new study published in the Annals of Internal Medicine finds that systematically collecting family history in a primary practice setting significantly increases the identification of high-risk people.

Nadeem Qureshi and colleagues in the ADDFAM (Added Value of Family History in CVD Risk Assessment) Study Group studied 748 people without known CV disease who were seen in 24 family practices in the U.K. In addition to a Framingham-based risk assessment, half the patients were randomized to a systematic review of their family history.

Incorporating a more rigorous assessment of family history identified more patients as being at high risk for CV disease (defined as a 10-year risk of at least 20%): the mean increase in the proportion of patients classified as high risk was 4.8 percentage points in the intervention practices versus 0.3 percentage points in the control practices. This translated to an increase in the number of patients classified as high risk from 49 to 69  (a 41% increase) in the intervention group and from 36 to 38 (a 6% increase) in the control group.

The authors say that a systematic assessment of family history is low cost and “feasible in practice and is acceptable to patients.” They conclude that their results “highlight the promising role that greater use of systematic family history collection could play in a targeted strategy in primary care.”

In an accompanying editorial, Alfred Berg praises the study, but points out that it “did not assess eventual clinical outcomes, a formidable task, but strongly suggests that a well-conducted evaluation would have a good chance of demonstrating clinical benefit if fully implemented and followed for a sufficient time.” Nevertheless, he believes the study “warrants planning for a more rigorous approach to family history and cardiac risk” and that “it is time to take systematic family history collection more seriously.”

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