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Johnson C, Chen J, McGowan MP, Tricou E, Card M, Pettit AR, Klaiman T, Rader DJ, Volpp KG, Beidas RS. Family cascade screening for equitable identification of familial hypercholesterolemia: study protocol for a hybrid effectiveness-implementation type III randomized controlled trial. Implement Sci 2024; 19:30. [PMID: 38594685 PMCID: PMC11003060 DOI: 10.1186/s13012-024-01355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/25/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a heritable disorder affecting 1.3 million individuals in the USA. Eighty percent of people with FH are undiagnosed, particularly minoritized populations including Black or African American people, Asian or Asian American people, and women across racial groups. Family cascade screening is an evidence-based practice that can increase diagnosis and improve health outcomes but is rarely implemented in routine practice, representing an important care gap. In pilot work, we leveraged best practices from behavioral economics and implementation science-including mixed-methods contextual inquiry with clinicians, patients, and health system constituents-to co-design two patient-facing implementation strategies to address this care gap: (a) an automated health system-mediated strategy and (b) a nonprofit foundation-mediated strategy with contact from a foundation-employed care navigator. This trial will test the comparative effectiveness of these strategies on completion of cascade screening for relatives of individuals with FH, centering equitable reach. METHODS We will conduct a hybrid effectiveness-implementation type III randomized controlled trial testing the comparative effectiveness of two strategies for implementing cascade screening with 220 individuals with FH (i.e., probands) per arm identified from a large northeastern health system. The primary implementation outcome is reach, or the proportion of probands with at least one first-degree biological relative (parent, sibling, child) in the USA who is screened for FH through the study. Our secondary implementation outcomes include the number of relatives screened and the number of relatives meeting the American Heart Association criteria for FH. Our secondary clinical effectiveness outcome is post-trial proband cholesterol level. We will also use mixed methods to identify implementation strategy mechanisms for implementation strategy effectiveness while centering equity. DISCUSSION We will test two patient-facing implementation strategies harnessing insights from behavioral economics that were developed collaboratively with constituents. This trial will improve our understanding of how to implement evidence-based cascade screening for FH, which implementation strategies work, for whom, and why. Learnings from this trial can be used to equitably scale cascade screening programs for FH nationally and inform cascade screening implementation efforts for other genetic disorders. TRIAL REGISTRATION ClinicalTrials.gov, NCT05750667. Registered 15 February 2023-retrospectively registered, https://clinicaltrials.gov/study/NCT05750667 .
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Affiliation(s)
- Christina Johnson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jinbo Chen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary P McGowan
- Family Heart Foundation, Fernandina Beach, FL, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Eric Tricou
- Family Heart Foundation, Fernandina Beach, FL, USA
| | - Mary Card
- Family Heart Foundation, Fernandina Beach, FL, USA
| | | | - Tamar Klaiman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Rader
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin G Volpp
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Ganokroj P, Muanpetch S, Deerochanawong C, Phimphilai M, Leelawattana R, Thongtang N, Krittayaphong R, Anthanont P, Vathesatogkit P, Sriphrapradang C, Senthong V, Torpongpun A, Suteerayongprasert P, Pengpong N, Sathavarodom N, Sunanta U, Porntharukchareon T, Kiatpanabhikul P, Kaewkrasaesin C, Suraamornkul S, Kongkit J, Umphonsathien M, Chattranukulchai P, Jiamjarasrungsi W, Khovidhunkit W. Gaps in the Care of Subjects with Familial Hypercholesterolemia: Insights from the Thai Familial Hypercholesterolemia Registry. J Atheroscler Thromb 2023; 30:1803-1816. [PMID: 37197952 DOI: 10.5551/jat.64081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
AIMS Familial hypercholesterolemia (FH) is currently underdiagnosed and undertreated. The establishment of a FH registry could facilitate a deeper understanding of this disease. We described the clinical characteristics of subjects with FH from the Thai FH Registry, compared our data with the regional and global data, and identified gaps in the care of these subjects. METHODS A multicenter, nationwide prospective FH registry was established in Thailand. Our data were compared with those of the European Atherosclerosis Society-FH Studies Collaboration. Multiple logistic regression analyses were performed for variables associated with lipid-lowering medication (LLM) use and the attainment of low-density lipoprotein-cholesterol (LDL-C) goal. RESULTS The study includes 472 subjects with FH (mean age at FH diagnosis: 46±12 years, 61.4% women). A history of premature coronary artery disease was found in 12%. The percentage of LLM use in subjects with a Dutch Lipid Clinic Network score of ≥ 6 (probable or definite FH) in our registry (64%) was slightly lower than the regional data but higher than the global data. Among those who received statins, 25.2% and 6.4% achieved LDL-C levels of <100 mg/dL and <70 mg/dL, respectively. Women with FH were less likely to achieve LDL-C <70 mg/dL (adjusted odds ratio: 0.22, 95% confidence interval: 0.06-0.71, p=0.012). CONCLUSIONS FH in Thailand was diagnosed late, and treatment was inadequate for the majority of subjects. Women with FH were less likely to achieve LDL-C goals. Our insights could potentially help raise awareness and narrow the gap in patient care.
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Affiliation(s)
- Poranee Ganokroj
- Department of Laboratory Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University
| | | | | | | | | | | | | | - Pimjai Anthanont
- Department of Medicine, Thammasat Hospital, Thammasat University
| | | | | | - Vichai Senthong
- Department of Medicine, Srinagarind Hospital, Khon Kaen University
| | - Artit Torpongpun
- Department of Medicine, Chonburi Hospital, Ministry of Public Health
| | | | | | | | | | | | | | | | | | - Jaruwan Kongkit
- Department of Medicine, Vachira Phuket Hospital, Ministry of Public Health
| | | | | | - Wiroj Jiamjarasrungsi
- Department of Preventive and Social Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University
| | - Weerapan Khovidhunkit
- Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University
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Huang H, Leung KSK, Garg T, Mazzoleni A, Miteu GD, Zakariya F, Awuah WA, Yin ETS, Haroon F, Hussain Z, Aji N, Jaiswal V, Tse G. Barriers and shortcomings in access to cardiovascular management and prevention for familial hypercholesterolemia during the COVID-19 pandemic. Clin Cardiol 2023; 46:831-844. [PMID: 37260143 PMCID: PMC10436799 DOI: 10.1002/clc.24059] [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] [Received: 02/10/2023] [Revised: 05/04/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a hereditary condition caused by mutations in the lipid pathway. The goal in managing FH is to reduce circulating low-density lipoprotein cholesterol and, therefore, reduce the risk of developing atherosclerotic cardiovascular disease (ASCVD). Because FH patients were considered high risk groups due to an increased susceptible for contracting COVID-19 infection, we hypothesized whether the effects of the pandemic hindered access to cardiovascular care. In this review, we conducted a literature search in databases Pubmed/Medline and ScienceDirect. We included a comprehensive analysis of findings from articles in English related and summarized the effects of the pandemic on cardiovascular care through direct and indirect effects. During the COVID-19 pandemic, FH patients presented with worse outcomes and prognosis, especially those that have suffered from early ASCVD. This caused avoidance in seeking care due to fear of transmission. The pandemic severely impacted consultations with lipidologists and cardiologists, causing a decline in lipid profile evaluations. Low socioeconomic communities and ethnic minorities were hit the hardest with job displacements and lacked healthcare coverage respectively, leading to treatment nonadherence. Lock-down restrictions promoted sedentary lifestyles and intake of fatty meals, but it is unclear whether these factors attenuated cardiovascular risk in FH. To prevent early atherogenesis in FH patients, universal screening programs, telemedicine, and lifestyle interventions are important recommendations that could improve outcomes in FH patients. However, the need to research in depth on the disproportionate impact within different subgroups should be the forefront of FH research.
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Affiliation(s)
- Helen Huang
- Royal College of Surgeons in IrelandFaculty of Medicine and Health ScienceDublinIreland
| | - Keith S. K. Leung
- Aston University Medical School, Faculty of Health & Life SciencesAston UniversityBirminghamUK
- Epidemiology Research Unit, Cardiovascular Analytics GroupChina‐UK CollaborationHong KongChina
| | - Tulika Garg
- Government Medical College and Hospital ChandigarhChandigarhIndia
| | - Adele Mazzoleni
- Barts and The London School of Medicine and DentistryLondonUK
| | - Goshen D. Miteu
- School of Biosciences, BiotechnologyUniversity of NottinghamNottinghamUK
- Department of BiochemistryCaleb University LagosLagosNigeria
| | - Farida Zakariya
- Department of Pharmaceutical SciencesAhmadu Bello UniversityZariaNigeria
| | | | | | | | - Zarish Hussain
- Royal College of Surgeons in IrelandMedical University of BahrainBusaiteenBahrain
| | - Narjiss Aji
- Faculty of Medicine and Pharmacy of RabatMohammed V UniversityRabatMorocco
| | - Vikash Jaiswal
- Department of Cardiology ResearchLarkin Community HospitalSouth MiamiFloridaUSA
| | - Gary Tse
- Epidemiology Research Unit, Cardiovascular Analytics GroupChina‐UK CollaborationHong KongChina
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
- Kent and Medway Medical SchoolCanterburyUK
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Wei S, Le N, Zhu JW, Breathett K, Greene SJ, Mamas MA, Zannad F, Van Spall HGC. Factors Associated With Racial and Ethnic Diversity Among Heart Failure Trial Participants: A Systematic Bibliometric Review. Circ Heart Fail 2021; 15:e008685. [PMID: 34911363 DOI: 10.1161/circheartfailure.121.008685] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure has a disproportionate burden on patients who are Black, Indigenous, and people of color (BIPOC), but not much is known about representation of these groups in randomized controlled trials (RCTs). We explored temporal trends in and RCT factors associated with the reporting of race and ethnicity data and the enrollment of BIPOC in heart failure RCTs. METHODS We searched MEDLINE, EMBASE, and CINAHL for heart failure RCTs published in journals with an impact factor ≥10 between January 1, 2000 and June 17, 2020. We used the Cochran-Armitage and Jonchkeere-Terpstra tests to examine temporal trends, and multivariable regression to assess the association between trial characteristics and outcomes. RESULTS Of 414 RCTs meeting inclusion criteria, only 157 (37.9% [95% CI, 33.2%-2.8%]) reported race and ethnicity data. Among 158 200 participants in these 157 RCTs, 29 512 (18.7% [95% CI, 18.5%-18.9%]) were BIPOC. There was a temporal increase in reporting of race and ethnicity data (29.5% in 2000-2003 to 54.7% in 2016-2020, P<0.001) and in enrollment of BIPOC (14.4% in 2000-2003 to 22.2% in 2016-2020, P=0.038). Trial leadership by a woman was independently associated with twice the odds of reporting race and ethnicity data (odds ratio, 2.0 [95% CI, 1.1-3.8]; P=0.028) and an 8.4% increase (95% CI, 1.9%-15.0%; P=0.013) in BIPOC enrollment. CONCLUSIONS A minority of heart failure RCTs reported race and ethnicity data, and among these, BIPOC were under-enrolled relative to disease distribution. Both reporting of race and ethnicity as well as enrollment of BIPOC increased between 2000 and 2020. After multivariable adjustment, trials led by women had greater odds of reporting race and ethnicity and enrolling BIPOC. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42021237497.
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Affiliation(s)
- Sunny Wei
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada. (S.W., N.L., J.W.Z., H.G.C.V.)
| | - NhatChinh Le
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada. (S.W., N.L., J.W.Z., H.G.C.V.)
| | - Jie Wei Zhu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada. (S.W., N.L., J.W.Z., H.G.C.V.)
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson (K.B.)
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC (S.J.G.)
| | - Mamas A Mamas
- Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.A.M.)
| | - Faiez Zannad
- Universite de Lorraine, Institut National de la Santé et de la Recherche Médicale (Inserm), Centre d'Investigations Cliniques-1433 and Inserm U1116, Centre Hospitalier Régional Universitaire Nancy, France (F.Z.)
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada. (S.W., N.L., J.W.Z., H.G.C.V.).,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. (H.G.C.V.).,Research Institute of St. Joe's Population Health Research Institute, Hamilton, Ontario, Canada (H.G.C.V.)
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