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Selected Works of Max Bulsara
Article
A new electronic screening tool for identifying risk of familial hypercholesterolaemia in general practice
Heart (2016)
  • Lakkhina Troeung, The University of Notre Dame Australia
  • Diane Arnold-Reed, The University of Notre Dame Australia
  • Wendy Chan She Ping-Delfos, The University of Notre Dame Australia
  • Gerald F Watts, The University of Western Australia
  • Jing Pang, The University of Western Australia
  • Marija Lugonja, Mosman Park Medical Group
  • Max Bulsara, The University of Notre Dame Australia
  • David Mortley, Mosman Park Medical Group
  • Matthew James, Royal North Shore Hospital
  • Tom Brett, The University of Notre Dame Australia
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Abstract
Objective To evaluate the performance of a new
electronic screening tool (TARB-Ex) in detecting general
practice patients at potential risk of familial
hypercholesterolaemia (FH).
Methods Medical records for all active patients seen
between 2012 and 2014 (n=3708) at a large general
practice in Perth, Western Australia were retrospectively
screened for potential FH risk using TARB-Ex. Electronic
extracts of medical records for patients identified with
potential FH risk (defined as Dutch Lipid Clinic Network
Criteria (DLCNC) score ≥5) through TARB-Ex were
reviewed by a general practitioner (GP) and lipid
specialist. High-risk patients were recalled for clinical
assessment to determine phenotypic FH diagnosis.
Performance was evaluated against a manual record
review by a GP in the subset of 360 patients with high
blood cholesterol (cholesterol ≥7 mmol/L or low-density
lipoprotein cholesterol ≥4.0 mmol/L).
Results Thirty-two patients with DLCNC score ≥5 were
identified through electronic screening compared with 22
through GP manual review. Sensitivity was 95.5% (95%
CI 77.2% to 99.9%), specificity was 96.7% (95% CI
94.3% to 98.3%), negative predictive accuracy was
99.7% (95% CI 98.3% to 100%) and positive
predictive accuracy was 65.6% (95% CI 46.9% to 8%).
Electronic screening was completed in 10 min compared
with 60 h for GP manual review. 10 of 32 patients
(31%) were considered high risk and recalled for clinical
assessment. Six of seven patients (86%) who attended
clinical assessment were diagnosed with phenotypic FH
on examination.
Conclusions TARB-Ex screening is a time-effective and
cost-effective method of systematically identifying
potential FH risk patients from general practice records
for clinical follow-up.
Disciplines
Publication Date
2016
DOI
10.1136/heartjnl-2015-308824
Citation Information
Troeung, L., Arnold-Reed, D., Chan She Ping-Delfos, W., Watts, G., Pang, J., Lugonja, M., Bulsara, M., Mortley, D., James, M., and Brett, T. (2016). A new electronic screening tool for identifying risk of familial hypercholesterolaemia in general practice. Heart, 102(11), 855-861. DOI: 10.1136/heartjnl-2015-308824