Background: Family members of patients with coronary heart disease (CHD) may themselves be at increased risk for developing CHD for genetic and(or behavioral reasons. Family history of CHD has been identified as an independent risk factor for CHD and a positive family history is generally associated with a 1.5- to 2-fold increase in the risk of CHD among first-degree relatives. Targeted approaches aimed at family members of those with established CHD may be a cost-effective way to identify high-risk persons and link them to effective risk factor modification interventions.
Objectives: (1) To determine the feasibility of recruiting family members to a Family Heart Health Program (FHHP) and (2) to assess the value of FHHP in the early identification of individuals at moderate and high risk for CHD.
Methods: Family members were identified via in-patients and cardiac rehabilitation participants at a regional cardiac referral center. Interested patients completed a family tree and mailed out personal invitations to their family members inviting them to register in the FHHP. Registered family members completed a risk factor and lifestyle assessment and received brief one-on-one counseling. The goals of the counseling session were to (a) provide an overview of heart disease and risk factors; (b) provide interpretation of personal risk; (c) promote behavior change through the development of an action plan; and (d) link patients to existing internal and community resources to support behavior change.
Results: To date, 255 Family Trees have been completed, and 596 family members have received an invitation. From the invitations, 262 (44%) family members (mean age: 51 +/- 14) have registered in the FHHP. FHHP participants were predominantly female (68%) and 52% were spouses. The risk assessment identified that 21% of the participants were at high risk and only 9.2% were at moderate risk according to the Framingham Risk Equation. When a combination of risk factors were considered (ie, smoking, physical inactivity, BMI, blood pressure, total cholesterol-to-HDL ratio, diabetes, and consumption of fruit and(or Vegetables), 92.6% had at least 1 risk factor, 36% had 2, and 29.5% had 3 or more risk factors.
Conclusions: This study indicated that it is feasible to recruit family members of CHD patients into an FHHP. Given the high percentage of spouses, alternative recruitment methods may be required to encourage greater participation by first-degree relatives. Preliminary data also suggest that the FHHP was an effective method for identifying individuals at high risk for CHD and providing early targeted interventions.