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Birkenhead K, Sullivan D, Watts GF, Sarkies MN. Implementation science and genetic testing for familial hypercholesterolemia. Curr Opin Lipidol 2025; 36:41-48. [PMID: 39590424 DOI: 10.1097/mol.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2024]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia is a treatable genetic disorder of cholesterol metabolism. Genetic testing is the most specific method for diagnosing familial hypercholesterolemia, but it remains underutilized. Implementation science aims to bridge the gap between evidence and practice and, thereby, support improved familial hypercholesterolemia care. This review presents the current evidence on the use of implementation science to improve the use of genetic testing for familial hypercholesterolemia. RECENT FINDINGS Recent research has focused on developing implementation strategies to improve the use of genetic testing, particularly cascade testing of at-risk blood relatives of known familial hypercholesterolemia cases. Stakeholder informed strategies aimed at improving communication between families and detection of familial hypercholesterolemia in primary care have been developed and implemented. Findings demonstrate implementation science methods can help remove barriers and improve the uptake of cascade genetic testing. SUMMARY Significant gaps in familial hypercholesterolemia care emphasize the importance of practical and realistic approaches to improve the detection of this preventable cause of premature heart disease, and recent efforts using implementation science have shown some promising results. More implementation science studies are needed that address the considerable gaps in familial hypercholesterolemia care, including the underutilization of genetic testing, so that all individuals receive the best clinical care.
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Affiliation(s)
- Karen Birkenhead
- School of Health Sciences, Faculty of Medicine and Health
- Implementation Science Academy, Sydney Health Partners, University of Sydney
| | - David Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, NSW Health Pathology
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales
| | - Gerald F Watts
- School of Medicine, University of Western Australia
- Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Mitchell N Sarkies
- School of Health Sciences, Faculty of Medicine and Health
- Implementation Science Academy, Sydney Health Partners, University of Sydney
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Morgan KM, Campbell-Salome G, Walters NL, Betts MN, Brangan A, Johns A, Kirchner HL, Lindsey-Mills Z, McGowan MP, Tricou EP, Rahm AK, Sturm AC, Jones LK. Innovative Implementation Strategies for Familial Hypercholesterolemia Cascade Testing: The Impact of Genetic Counseling. J Pers Med 2024; 14:841. [PMID: 39202032 PMCID: PMC11355397 DOI: 10.3390/jpm14080841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/03/2024] Open
Abstract
The IMPACT-FH study implemented strategies (packet, chatbot, direct contact) to promote family member cascade testing for familial hypercholesterolemia (FH). We evaluated the impact of genetic counseling (GC) on medical outcomes, strategy selection, and cascade testing. Probands (i.e., patients with FH) were recommended to complete GC and select sharing strategies. Comparisons were performed for both medical outcomes and strategy selection between probands with or without GC. GEE models for Poisson regression were used to examine the relationship between proband GC completion and first-degree relative (FDR) cascade testing. Overall, 46.3% (81/175) of probands completed GC. Probands with GC had a median LDL-C reduction of -13.0 mg/dL (-61.0, 4.0) versus -1.0 mg/dL (-16.0, 17.0) in probands without GC (p = 0.0054). Probands with and without GC selected sharing strategies for 65.3% and 40.3% of FDRs, respectively (p < 0.0001). Similarly, 27.1% of FDRs of probands with GC completed cascade testing, while 12.0% of FDRs of probands without GC completed testing (p = 0.0043). Direct contact was selected for 47 relatives in total and completed for 39, leading to the detection of 18 relatives with FH. Proband GC was associated with improved medical outcomes and increased FDR cascade testing. Direct contact effectively identified FH cases for the subset who participated.
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Affiliation(s)
- Kelly M. Morgan
- Department of Genomic Health, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA; (G.C.-S.); (N.L.W.); (A.B.); (Z.L.-M.); (A.C.S.)
| | - Gemme Campbell-Salome
- Department of Genomic Health, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA; (G.C.-S.); (N.L.W.); (A.B.); (Z.L.-M.); (A.C.S.)
- Department of Population Health Sciences, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA;
| | - Nicole L. Walters
- Department of Genomic Health, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA; (G.C.-S.); (N.L.W.); (A.B.); (Z.L.-M.); (A.C.S.)
| | - Megan N. Betts
- WellSpan Health, 605 S. George Street, York, PA 17401, USA;
| | - Andrew Brangan
- Department of Genomic Health, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA; (G.C.-S.); (N.L.W.); (A.B.); (Z.L.-M.); (A.C.S.)
| | - Alicia Johns
- Biostatistics Core, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA;
| | - H. Lester Kirchner
- Department of Population Health Sciences, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA;
| | - Zoe Lindsey-Mills
- Department of Genomic Health, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA; (G.C.-S.); (N.L.W.); (A.B.); (Z.L.-M.); (A.C.S.)
| | - Mary P. McGowan
- Family Heart Foundation, 605 E. Colorado Blvd Ste 180, Pasadena, CA 91101, USA (E.P.T.)
| | - Eric P. Tricou
- Family Heart Foundation, 605 E. Colorado Blvd Ste 180, Pasadena, CA 91101, USA (E.P.T.)
| | - Alanna Kulchak Rahm
- Department of Genomic Health, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA; (G.C.-S.); (N.L.W.); (A.B.); (Z.L.-M.); (A.C.S.)
| | - Amy C. Sturm
- Department of Genomic Health, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA; (G.C.-S.); (N.L.W.); (A.B.); (Z.L.-M.); (A.C.S.)
- Heart and Vascular Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA
- 23andMe, 223 N. Mathilda Avenue, Sunnyvale, CA 94086, USA
| | - Laney K. Jones
- Department of Genomic Health, Research Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA; (G.C.-S.); (N.L.W.); (A.B.); (Z.L.-M.); (A.C.S.)
- Heart and Vascular Institute, Geisinger, 100 N. Academy Avenue, Danville, PA 17922, USA
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