Implementation of guidelines to screen relatives of patients with premature coronary heart disease in a hospital setting

Abstract

First-degree relatives of patients with premature coronary heart disease (CHD) bear a substantial excessive risk of CHD; however, multiple barriers may prevent risk factor screening. We examined the feasibility of family screening in a university hospital setting. Consecutive men <55 and women <65 years old admitted to the cardiology ward for coronary angiography and/or angioplasty, acute coronary syndrome, or after coronary artery bypass surgery attended a follow-up clinic visit within 6 months. Of 600 probands with eligible siblings, 78% agreed to contact their siblings, and of 480 probands with eligible children, 93% agreed to contact their children. Proband characteristics that predicted (p <0.05) successful screening of children were female gender (odds ratio [OR] 2.0), nonimmigrants (OR 2.3), and low educational level (OR 1.7). Predictors of screening of siblings were age (OR 0.95), female gender (OR 2.0), nonimmigrants (OR 4.0), and cigarette smoker (OR 0.6). Sisters and daughters were more likely to complete screening than brothers and sons. Among screened brothers and sisters, 15% and 8% had CHD or a CHD risk equivalent, respectively; moreover, 71% and 46%, respectively, had ≥1 additional major CHD risk factor. Only 3% of sons and 2% of daughters had CHD or a CHD risk equivalent; however, 50% and 40%, respectively, had ≥1 additional CHD risk factor, primarily smoking. These findings indicate that most patients with premature CHD were willing to contact relatives for screening. Screening yielded a substantial percentage of relatives with additional CHD risk factors.