Abstract P456: Screening Strategies and Primary Prevention Interventions for Relatives of Individuals with Coronary Heart Disease: A Systematic Review
Introduction: Targeting relatives of individuals with coronary artery disease (CAD) may be an effective primary prevention strategy. However, a systematic review of (1) reported screening strategies to identify relatives at risk and (2) published risk factor interventions in family members has not been performed which may limit more widespread adoption.
Methods: We searched PubMed, Embase and The Cochrane Library from inception to October 1, 2013 for articles describing screening strategies and primary prevention interventions targeting family members of patients with CAD. A three-part search term composed of “coronary heart disease”, “relatives” and “screening or intervention” along with related MeSH terms was designed for maximum sensitivity.
Results: We identified 14 eligible articles for the analysis of screening strategies. The proband was identified most commonly during index hospitalization (n=11), but also while in a cardiac rehabilitation center (n=1) and by referral from a primary care physician (n=2). Studies in which the proband was explicitly encouraged to recruit family members were slightly more effective (participation rate of 24-91%; weighted average: 78%) than screening strategies in which the relative was only contacted by phone and/or letter (participation rate: 36-95%; weighted average: 68%). In most studies, the willingness of the proband to contact relatives for screening was high (range: 62-98%, mean 87%). Thirteen studies were identified that examined interventions in relatives of people with CAD (randomized controlled trials, n=11; prospective cohort, n=2), ranging in size from 18 to 3,981 participants. A multiple risk factor intervention was performed in 8 studies, while 3 studies looked at single risk factor intervention and 2 studies encouraged the patient to seek cardiovascular risk factor treatment from primary care physicians. Significant improvement in at least 1 modifiable cardiovascular health behavior or risk factor was observed in the intervention arm of all studies (n = 13).
Conclusions: Screening strategies targeting family members achieve a high participation rate especially when the proband initiates screening. Interventions that target relatives appear to be feasible and effective in improving risk factors or health behaviours. Primary prevention delivery models targeting family members of individuals with CAD warrant further study.
Author Disclosures: M. Goldfarb: None. D. Slobod: None. G. Thanassoulis: D. Speakers Bureau; Modest; Servier Canada. G. Consultant/Advisory Board; Modest; Servier Canada.
- © 2014 by American Heart Association, Inc.