Abstract 15090: Impact of Disclosure of Genetic Risk for Coronary Heart Disease on Physician Attitudes and Decision-Making: The MI-GENES Study
Introduction: Whether electronic health record (EHR)-based disclosure of genetic risk of coronary heart disease (CHD) influences physician decision-making and attitudes toward clinical use of genomic information is unknown.
Hypothesis: We hypothesized that receipt of a multi-locus CHD genetic risk score (GRS) for a patient would lead to positive physician attitudes regarding incorporation of genomic information in clinical practice and assist with clinical decision-making.
Methods: The MI-GENES trial randomized patients aged 45-65 years (n=203) at intermediate risk for CHD to receive conventional risk scores (‘CRS encounters’) or CRS plus a 28-variant GRS (‘GRS encounters’). Risk was disclosed using an EHR-based decision aid, along with genetic counseling and physician discussion. All study physicians had both CRS and GRS encounters. A survey was completed by study physicians following risk disclosure encounters. Data were analyzed using logistic regression and expressed as odds ratio (OR) with 95% confidence intervals. For responses with low frequency, data were analyzed using Fisher’s exact test, and p-values were reported.
Results: Academic faculty cardiologists (n=4) and internists (n=2) participated in the disclosure of GRS/CRS risk to patients. Following GRS encounters, physicians were more likely to report that they would use the genetic risk score if it becomes available in the future (100% versus 83%, p=0.0001), and to recommend CHD genetic testing to family members if available in the future (OR 16.38 (4.67-103.89), p=<0.0001), than following CRS encounters. After encounters with patients with high GRS, physicians were more likely to report comfort discussing genetic risk (p=0.03), and that GRS disclosure helped further risk stratify the patient (OR 3.84 (1.59-9.93), p=0.003) and led to statin initiation (OR 2.51, CI 1.14-5.63, p=0.02), than after encounters with patients with low GRS. For patients without GRS disclosure, 67% of physicians expressed that the GRS would have aided decision making.
Conclusions: Availability of a multi-locus GRS for CHD associated with positive physician attitudes toward incorporation of genomic information in clinical practice and assisted with clinical decision-making in precision medicine.
Author Disclosures: S. Brown: None. H. Jouni: None. I. Kullo: None.
- © 2016 by American Heart Association, Inc.