Castiel Jonathan, Chen-Tournoux Annabel, Thanassoulis George, Goldfarb Michael
Lander College for Men/Touro College, Queens, New York, USA.
Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
CJC Open. 2020 Jun 25;2(6):506-513. doi: 10.1016/j.cjco.2020.06.014. eCollection 2020 Nov.
Screening 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).
Patients 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.
There 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, < 0.001), and 30.4% (7 of 23) of FMs had a low FRS who had initially had an intermediate or high FRS.
A 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.
对缺血性心脏病患者的亲属进行筛查，可以识别出超过一半心血管（CV）危险因素控制不佳的人群。在亲属入住心血管重症监护病房（CICU）时，家庭成员（FMs）可能有很高的积极性接受CV一级预防筛查。
因急性冠状动脉事件入住三级CICU的70岁及以下患者收到一封信，信中推荐FMs进行CV筛查。感兴趣的FMs接受了CV危险因素评估和一级预防咨询。目的是识别具有中等或高修正10年弗雷明汉风险评分（FRS）的FMs，并评估以家庭为导向的一级预防策略是否能改善CV风险。
有51名CV先证者推荐了101名FMs（62名家庭成员，39名住户；平均年龄：44.8±15.3岁；65名（64.4%）为女性）进行筛查。年龄≥30岁的FMs中有三分之一（84名中的28名；32.1%）新诊断出高血压、糖尿病或血脂异常。近一半的FMs（38名；45.2%）具有中等或高修正弗雷明汉10年CV风险。在参加6个月随访的年龄≥30岁的FMs中（84名中的51名；60.7%），平均FRS下降了4.6%（从13.2%±12.7降至8.6%±10.0，P<0.001），最初具有中等或高FRS的FMs中有30.4%（23名中的7名）FRS降低。
在CICU入院时采用患者主导的转诊策略，可使FMs中先前未诊断出的CV危险因素的识别率很高。大规模实施类似的转诊计划可能会发现相当大的CV风险负担。
