A Patient-Led Referral Strategy for Cardiovascular Screening of Family and Household Members at the Time of Cardiac Intensive Care Unit Admission

Abstract

BackgroundScreening relatives of patients with ischemic heart disease can identify over half of the population with poorly controlled cardiovascular (CV) risk factors. Family or household members (FMs) may be highly motivated to undergo CV primary prevention screening at the time of their relative’s admission to the Cardiovascular Intensive Care Unit (CICU). MethodsPatients aged ≤ 70 years admitted to a tertiary CICU for an acute coronary event were given a letter to refer FMs for CV screening. Interested FMs underwent CV risk-factor assessment and primary prevention counselling. The objectives were to identify FMs with an intermediate or high modified 10-year Framingham risk score (FRS) and to evaluate whether a family-oriented primary prevention strategy improved CV risk. ResultsThere were 51 CV probands who referred 101 FMs (62 family, 39 household; mean age: 44.8 ± 15.3; 65 (64.4%) female) for screening. One-third of FMs aged ≥ 30 years (n = 28 of 84; 32.1%) had a new diagnosis of either hypertension, diabetes, or dyslipidemia. Nearly half of FMs (n = 38; 45.2%) had an intermediate or high modified Framingham 10-year CV risk. In FMs aged ≥ 30 years attending the 6-month follow-up (51 of 84; 60.7%), the mean FRS decreased by 4.6% (from 13.2% ± 12.7 to 8.6% ± 10.0, P < 0.001), and 30.4% (7 of 23) of FMs had a low FRS who had initially had an intermediate or high FRS. ConclusionsA patient-led referral strategy at the time of CICU admission led to a high rate of identification of previously undiagnosed CV risk factors in FMs. Implementing a similar referral program on a larger scale could identify a considerable burden of CV risk.