Availability and quality of coronary heart disease family history in primary care medical records: implications for cardiovascular risk assessment

Abstract

Background: The potential to use data on family history of premature disease to assess disease risk is increasingly recognised, particularly in scoring risk for coronary heart disease (CHD). However the quality of family health information in primary care records is unclear.

Aim: To assess the availability and quality of family history of CHD documented in electronic primary care records.

Design: Cross-sectional study.

Setting: 537 UK family practices contributing to The Health Improvement Network database.

Method: Data were obtained from patients aged 20 years or more, registered with their current practice between 1(st) January 1998 and 31(st) December 2008, for at least one year. The availability and quality of recorded CHD family history was assessed using multilevel logistic and ordinal logistic regression respectively.

Results: In a cross-section of 1,504,535 patients, 19% had a positive or negative family history of CHD recorded. Multilevel logistic regression showed patients aged 50-59 had higher odds of having their family history recorded compared to those aged 20-29 (OR:1.23 (1.21 to 1.25)), however most deprived patients had lower odds compared to those least deprived (OR: 0.86 (0.85 to 0.88)). Of the 140,058 patients with a positive family history recorded (9% of total cohort), age of onset was available in 45%; with data specifying both age of onset and relative affected available in only 11% of records. Multilevel ordinal logistic regression confirmed no statistical association between the quality of family history recording and age, gender, deprivation and year of registration.

Conclusion: Family history of CHD is documented in a small proportion of primary care records; and where positive family history is documented the details are insufficient to assess familial risk or populate cardiovascular risk assessment tools. Data capture needs to be improved particularly for more disadvantaged patients who may be most likely to benefit from CHD risk assessment.

Figure 1. Demographic trends of patients with FH of CHD recorded, by age category and year of registration.

Values are out of the total sample: 1,389,965 (excl missing values). Reports the proportion of patients with any FH of CHD within each subgroup (age group and year of practice registration).

Figure 2. Pattern of FH quality by year of registration, Townsend score and age category (excluding missing values).