title: Effect of adding systematic family history enquiry to cardiovascular disease risk assessment in primary care: a matched-pair, cluster randomized trial.
abstract: BACKGROUND
  Evidence of the value of systematically collecting family history in primary care is limited.
  
  
  OBJECTIVE
  To evaluate the feasibility of systematically collecting family history of coronary heart disease in primary care and the effect of incorporating these data into cardiovascular risk assessment.
  
  
  METHODS
  Pragmatic, matched-pair, cluster randomized, controlled trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN 17943542).
  
  
  METHODS
  24 family practices in the United Kingdom.
  
  
  METHODS
  748 persons aged 30 to 65 years with no previously diagnosed cardiovascular risk, seen between July 2007 and March 2009.
  
  
  METHODS
  Participants in control practices had the usual Framingham-based cardiovascular risk assessment with and without use of existing family history information in their medical records. Participants in intervention practices also completed a questionnaire to systematically collect their family history. All participants were informed of their risk status. Participants with high cardiovascular risk were invited for a consultation.
  
  
  METHODS
  The primary outcome was the proportion of participants with high cardiovascular risk (10-year risk ≥ 20%). Other measures included questionnaire completion rate and anxiety score.
  
  
  RESULTS
  98% of participants completed the family history questionnaire. The mean increase in proportion of participants classified as having high cardiovascular risk was 4.8 percentage points in the intervention practices, compared with 0.3 percentage point in control practices when family history from patient records was incorporated. The 4.5-percentage point difference between groups (95% CI, 1.7 to 7.2 percentage points) remained significant after adjustment for participant and practice characteristics (P = 0.007). Anxiety scores were similar between groups.
  
  
  CONCLUSIONS
  Relatively few participants were from ethnic minority or less-educated groups. The potential to explore behavioral change and clinical outcomes was limited. Many data were missing for anxiety scores.
  
  
  CONCLUSIONS
  Systematically collecting family history increases the proportion of persons identified as having high cardiovascular risk for further targeted prevention and seems to have little or no effect on anxiety.
  
  
  BACKGROUND
  Genetics Health Services Research program of the United Kingdom Department of Health.
authors.affiliation: University of Nottingham, United Kingdom. nadeem.qureshi@nottingham.ac.uk
authors.forename: Nadeem
authors.initials: N
authors.lastname: Qureshi
authors.forename: Sarah
authors.initials: S
authors.lastname: Armstrong
authors.forename: Paula
authors.initials: P
authors.lastname: Dhiman
authors.forename: Paula
authors.initials: P
authors.lastname: Saukko
authors.forename: Joan
authors.initials: J
authors.lastname: Middlemass
authors.forename: Philip H
authors.initials: PH
authors.lastname: Evans
authors.forename: Joe
authors.initials: J
authors.lastname: Kai
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000523:psychology; D057286:Electronic Health Records; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008487:Medical History Taking; D008875:Middle Aged; D011320:Primary Health Care; D018570:Risk Assessment; D011795:Surveys and Questionnaires