Availability and Quality of Coronary Heart Disease Family History in Primary Care Medical Records Implications for Cardiovascular Risk Assessment.docVIP

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Availability and Quality of Coronary Heart Disease Family History in Primary Care Medical Records Implications for Cardiovascular Risk Assessment.doc

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Availability and Quality of Coronary Heart Disease Family History in Primary Care Medical Records Implications for Cardiovascular Risk Assessment

AvailabilityandQualityofCoronaryHeartDisease FamilyHistoryinPrimaryCareMedicalRecords: ImplicationsforCardiovascularRiskAssessment PaulaDhiman1,JoeKai1,LauraHorsfall2,KateWalters2,NadeemQureshi1* 1SchoolofMedicine,DivisionofPrimaryCare,UniversityofNottingham,UniversityPark,Nottingham,UnitedKingdom,2TheResearchDepartmentofPrimaryCareand PopulationHealth,UniversityCollegeofLondon(UCL),London,UnitedKingdom Abstract Background: The potential to use data on family history of premature disease to assess disease risk is increasingly recognised,particularlyinscoringriskforcoronaryheartdisease(CHD).Howeverthequalityoffamilyhealthinformationin primarycarerecordsisunclear. Aim:ToassesstheavailabilityandqualityoffamilyhistoryofCHDdocumentedinelectronicprimarycarerecords Design:Cross-sectionalstudy Setting:537UKfamilypracticescontributingtoTheHealthImprovementNetworkdatabase. Method: Data were obtained from patients aged 20 years or more, registered with their current practice between 1st January1998and31stDecember2008,foratleastoneyear.TheavailabilityandqualityofrecordedCHDfamilyhistorywas assessedusingmultilevellogisticandordinallogisticregressionrespectively. Results:Inacross-sectionof1,504,535patients,19%hadapositiveornegativefamilyhistoryofCHDrecorded.Multilevel logisticregressionshowedpatientsaged50–59hadhigheroddsofhavingtheirfamilyhistoryrecordedcomparedtothose aged20–29(OR:1.23(1.21to1.25)),howevermostdeprivedpatientshadloweroddscomparedtothoseleastdeprived(OR: 0.86(0.85to0.88)).Ofthe140,058patientswithapositivefamilyhistoryrecorded(9%oftotalcohort),ageofonsetwas availablein45%;withdataspecifyingbothageofonsetandrelativeaffectedavailableinonly11%ofrecords.Multilevel ordinal logistic regression confirmed no statistical association between the quality of family history recording and age, gender,deprivationandyearofregistration. Conclusion:FamilyhistoryofCHDisdocumentedinasmallproportionofprimarycarerecords;andwherepositivefamily historyisdocumentedthedetailsareinsuffici