Practitioners' Confidence and Desires for Education in Cardiovascular and Sudden Cardiac Death Genetics

Abstract

Background Educating cardiologists and health care professionals about cardiovascular genetics and genetic testing is essential to improving diagnosis and management of patients with inherited cardiomyopathies and arrhythmias and those at higher risk for sudden cardiac death. The aim of this study was to understand cardiology and electrophysiology practitioners' current practices, confidence, and knowledge surrounding genetic testing in cardiology and desired topics for an educational program. Methods and Results A one-time survey was administered through purposive email solicitation to 131 cardiology practitioners in the United States. Of these, 107 self-identified as nongenetic practitioners. Over three quarters of nongenetic practitioners reported that they refer patients to genetic providers to discuss cardiovascular genetic tests (n=82; 76.6%). More than half of nongenetic practitioners reported that they were not confident about the types of cardiovascular genetic testing available (n=60; 56%) and/or in ordering appropriate cardiovascular genetic tests (n=66; 62%). In addition, 45% (n=22) of nongenetic practitioners did not feel confident making cardiology treatment recommendations based on genetic test results. Among all providers, the most desired topics for an educational program were risk assessment (94%) and management of inherited cardiac conditions based on guidelines (91%). Conclusions This study emphasizes the importance of access to genetics services in the cardiology field and the need for addressing the identified deficit in confidence and knowledge about cardiogenetics and genetic testing among nongenetic providers. Additional research is needed, including more practitioners from underserved areas.

Keywords: cardiogenomics; cardiology; continuing medical education; genetic testing.

Figure 1. Frequency with which genetics and nongenetics professionals discuss, refer, and perform genetic testing for their patients.

A, Responses to the question, “How often did you discuss genetic testing for inherited cardiac conditions with patients in 2019?” B, Responses to the question, “How often did you refer said patients to genetics?” C, Responses to the question, “How often are genetic tests performed for your patients?” For all 4 panels, responses between genetics and nongenetics professionals were statistically significantly different (P<0.005). NA indicates not applicable.

Figure 2. Preferences for discussions about genetic testing options.

Providers were asked how they handled each of the following clinical scenarios: A, Discussing options for genetic testing. B, Discussing the implications of a positive result with a patient. C, Discussing the implications of variant of uncertain significance with a patient. D, Discussing the implications of genetic testing results for family members. For all 4 panels, responses between genetics and nongenetics professionals were statistically significantly different (P<0.005). NA indicates not applicable.

Figure 3. Health care providers’ confidence in their knowledge about genetic testing in cardiology.

Participants’ responses to 13 “I feel confident in …” statements. Respondents were asked to assess how confident they felt with each task on a Likert scale, from “strongly disagree” to “strongly agree.” Percentages along the left axis represent the percentages of participants who are not confident in the task (participants who “strongly disagreed” or “disagreed”). Percentages centered in the gray boxes represent percentages of participants who neither agree nor disagree to have confidence in the task. Percentages along the right axis represent the percentages of participants who feel confident with the task (participants who “strongly agreed” or “agreed”). With the exception of confidence to “identify the best person to initiate genetic testing,” confidence scores for all questions differed statistically significantly (P<0.005) between genetics and nongenetics professionals. VUS indicates variant of uncertain significance.

Figure 4. Desired topics for an educational program about cardiovascular genetic testing.

Respondents were asked to indicate whether they would like to see the following topics covered in a continuing medical education program about genetic testing relevant to cardiology using a Likert scale, ranging from strongly disagree to strongly agree. Percentages along the left axis represent the percentages of participants who would not like to have the topic included in the educational program (participants who “strongly disagreed” or “disagreed”). Percentages centered in the gray boxes represent percentages of participants who neither agree nor disagree to have the topic included in the educational program. Percentages along the right axis represent the percentages of participants who would like to have the topic included in the educational program (participants who “strongly agreed” or “agreed”).