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Title: | Comparative aspects of the care of familial hypercholesterolemia in the ""Ten Countries Study"" |
Authors: | PANG, Jing; CHAN, Dick C.; HU, Miao; MUIR, Lauretta A.; KWOK, See; CHARNG, Min-Ji; FLORKOWSKI, Christopher M.; GEORGE, Peter M.; LIN, Jie; Do Doan Loi; MARAIS, A. David; NAWAWI, Hapizah M.; GONZALEZ-SANTOS, Lourdes E.; SU, Ta-Chen; Thanh Huong Truong; SANTOS, Raul D.; SORAN, Handrean; TOMLINSON, Brian; YAMASHITA, Shizuya; ADEMI, Zanfina; WATTS, Gerald F. |
Citation: | JOURNAL OF CLINICAL LIPIDOLOGY, v.13, n.2, p.287-300, 2019 |
Abstract: | BACKGROUND: There is a lack of information on the health care of familial hypercholesterolemia (FH). OBJECTIVE: The objective of this study was to compare the health care of FH in countries of the Asia-Pacific region and Southern Hemisphere. METHODS: A series of questionnaires were completed by key opinion leaders from selected specialist centers in 12 countries concerning aspects of the care of FH, including screening, diagnosis, risk assessment, treatment, teaching/training, and research; the United Kingdom (UK) was used as the international benchmark. RESULTS: The estimated percentage of patients diagnosed with the condition was low (overall <3%) in all countries, compared with similar to 15% in the UK. Underdetection of FH was associated with government expenditure on health care (x = 0.667, P<.05). Opportunistic and systematic screening methods, and the Dutch Lipid Clinic Network criteria were most commonly used to detect FH; genetic testing was infrequently used. Noninvasive imaging of coronary calcium and/or carotid plaques was underutilized in risk assessment. Patients with FH were generally not adequately treated, with <30% of patients achieving guideline recommended low-density lipoprotein cholesterol targets on conventional therapies. Treatment gaps included suboptimal availability and use of lipoprotein apheresis and proprotein convertase subtilsin-kexin type 9 inhibitors. A deficit of FH registries, training programs, and publications were identified in less economically developed countries. The demonstration of cost-effectiveness for cascade screening, genetic testing, and specialized treatments were significantly associated with the availability of subsidies from the health care system (x = 0.571-0.800, P<.05). CONCLUSION: We identified important gaps across the continuum of care for FH, particularly in less economically developed countries. Wider implementation of primary and pediatric care, telehealth services, patient support groups, education/training programs, research activities, and health technology assessments are needed to improve the care of patients with FH in these countries. |
Appears in Collections: | Artigos e Materiais de Revistas Científicas - FM/MCP Artigos e Materiais de Revistas Científicas - HC/InCor |
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