Background and aims
Diagnosis rates of familial hypercholesterolemia (FH) remain low. We implemented FH ALERT to assess whether alerting physicians for the possibility of FH impacted additional diagnostic activity.
Methods
The study was conducted from SYNLAB laboratory Weiden (Bavaria). Beyond common reporting of LDL-C or TC, 1,411 physicians covering approximately a population of 1.5 million people were eligible to receive an alert letter (AL) including information on FH, if laboratory results exceeded thresholds as follows: adults LDL-C ≥190-250 mg/dl (to convert into mmol/l multiply with 0,0259), TC ≥250 to ≤310 mg/dl (probable suspicion); LDL-C >250 mg/dl and TC >310 mg/dl (strong suspicion). Persons below 18 years were alerted for LDL-C ≥140 mg/dl and TC ≥200 mg/dl (strong suspicion). Patients above 60 years were excluded. Our readouts were characteristics of involved physicians, rate of ALs issued, acceptance, and subsequent diagnostic activity.
Results
Physicians were mainly general practitioners in ambulatory care. 75% of the ordered tests were for TC, 25% for LDL-C. We issued 3,512 ALs (~5% of tests). 86% of eligible physicians stayed with the initiative, 32.7% were alerted, and 70% were positive upon call-center survey. We registered 101 new visitors of www.fhscore.eu and sent out 93 kits for genetics. Thereof, 26 were returned and 5 patients were positive for FH.
Conclusions
Although physicians appeared open to our approach, recommendations were hardly translated into action. The reasons behind this are elusive. Further education is required, and our simple alerting system may not suffice to improve FH detection in the community.