van der Werf Christian, Onderwater Astrid T, van Langen Irene M, Smets Ellen M A
Department of Cardiology, Heart Failure Research Centre, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Medical Psychology, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands.
Eur J Hum Genet. 2014 Feb;22(2):192-6. doi: 10.1038/ejhg.2013.126. Epub 2013 Jun 5.
Relatives of young sudden cardiac death (SCD) victims are at increased risk of carrying a potentially fatal inherited cardiac disease. Hence, it is recommended to perform an autopsy on the victim and to refer his or her relatives to a cardiogenetics clinic for a full evaluation to identify those at risk and allow preventive measures to be taken. However, at present, the number of families attending a cardiogenetics clinic after the SCD of a young relative is low in the Netherlands. We performed a qualitative study and report on the experiences and attitudes of first-degree relatives who attended a cardiogenetics clinic for evaluation. In total, we interviewed nine first-degree relatives and one spouse of seven SCD victims about their experiences, considerations and emotions before attendance and at the first stage of the cardiogenetic evaluation before DNA results were available. Interviews were transcribed verbatim and analysed. Medical professionals did not have an important role in informing or referring relatives to a cardiogenetics clinic. Importantly, all participants indicated that they would have appreciated a more directive approach from medical professionals, because their mourning process hampered their own search for information and decision-making. A need to understand the cause of death and wanting to prevent another SCD event occurring in the family were the most important reasons for attending a clinic. There are possibilities to improve the information process and better support their decision-making. The multidisciplinary cardiogenetic evaluation was appreciated, but could be improved by minor changes in the way it is implemented.
年轻心脏性猝死(SCD)受害者的亲属携带潜在致命遗传性心脏病的风险增加。因此,建议对受害者进行尸检,并将其亲属转介至心脏遗传学诊所进行全面评估,以识别有风险的人并采取预防措施。然而,目前在荷兰,年轻亲属发生心脏性猝死之后前往心脏遗传学诊所就诊的家庭数量较少。我们开展了一项定性研究,并报告了前往心脏遗传学诊所进行评估的一级亲属的经历和态度。我们总共采访了9名一级亲属以及7名SCD受害者中的1名配偶,了解他们在就诊前以及在DNA检测结果出来之前的心脏遗传学评估第一阶段的经历、考虑因素和情绪。访谈内容逐字记录并进行了分析。医学专业人员在告知亲属或转介其前往心脏遗传学诊所方面没有发挥重要作用。重要的是,所有参与者均表示,他们希望医学专业人员采取更具指导性的方法,因为他们的哀悼过程妨碍了自身获取信息和做出决策。了解死亡原因以及希望防止家庭中再次发生SCD事件是前往诊所就诊的最重要原因。存在改善信息流程并更好地支持他们决策的可能性。多学科心脏遗传学评估受到了好评,但在实施方式上稍作改变就能得到改进。