Screening family members at high risk for coronary disease. Why isn't it done?
BACKGROUND
The National Cholesterol Education Program strongly recommends screening family members of patients with early cardiovascular disease (CVD) for coronary risk factors, but the physician and patient compliance with this recommendation has not been extensively studied. The American College of Cardiology Evaluation of Preventive Therapeutics (ACCEPT) study, a national survey conducted in 1996-1997, determined if physicians were screening first-degree relatives of patients with early CVD.


METHODS
The ACCEPT study included 5553 patients with either their first bypass surgery, first angioplasty, an acute myocardial infarction, or myocardia ischemia, admitted to 53 hospitals throughout the United States.


METHODS
Self-reported screening of first-degree relatives obtained by interview follow-up 6 months after event.


RESULTS
Less than 1% of inpatient medical records contained a discharge plan by the physician recommending screening family members of patients younger than age 55. Only 17.8% of these patients had their family screened within 6 months of their cardiovascular event, while only 19.6% with a recognized family history of premature coronary artery disease had their family screened. The only factors that were significant (p<0. 05) predictors of successful family screening were education (19.4%), having high cholesterol (16.4%), being widowed (18.1%), not smoking (16.4%), and being black (20.5%).


CONCLUSIONS
U.S. physicians do not appear to follow national recommendations for the screening of family members of their high-risk patients. These data also suggest that physicians are not ready to use and exploit known genetic factors in treating CVD even as the human genome data become available for clinical use.
Swanson
J R
JR
Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14623, USA.
Pearson
T A
TA
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003327:Coronary Disease / Q000175:diagnosis* / Q000235:genetics* / Q000401:mortality; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D005820:Genetic Testing / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D010375:Pedigree; D011159:Population Surveillance; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology