Assessment of physicians’ awareness and knowledge of familial hypercholesterolemia in Saudi Arabia: Is there a gap?

<div><p>Background</p><p>The scarcity of familial hypercholesterolemia (FH) cases reported in Saudi Arabia might be indicative of a lack of awareness of this common genetic disease among physicians.</p><p>Objective</p><p>To assess physicians’ awareness, practice, and knowledge of FH in Saudi Arabia.</p><p>Methods</p><p>This is a cross-sectional study conducted among physicians at four tertiary hospitals in Riyadh, Saudi Arabia between March 2016 and May 2016 using a self-administered questionnaire.</p><p>Results</p><p>A total of 294 physicians completed the survey (response rate 90.1%). Overall, 92.9% of the participants have poor knowledge of FH while only 7.1% have acceptable knowledge. The majority (68.7%) of physicians rated their familiarity with FH as average or above average, and these had higher mean knowledge scores than participants with self-reported below average familiarity (mean 3.4 versus 2.6) (P < 0.001). Consultant physicians were 4.2 times more likely to be familiar with FH than residents or registrars (OR = 4.2, 95% CI = 1.9–9.1, P < 0.001). Physicians who currently managed FH patients had higher mean knowledge scores compared to those without FH patients in their care (3.5 versus 2.9) (P = 0.006). In addition, there were statistically significant differences between physicians’ mean knowledge scores and their ages, levels of training, and years in practice. Moreover, a substantial deficit was identified in the awareness of various clinical algorithms to diagnose patients with FH, cascade screening, specialist lipid services, and the existence of statin alternatives, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.</p><p>Conclusion</p><p>A substantial deficit was found in the awareness, knowledge, practice, and detection of FH among physicians in Saudi Arabia. Extensive educational programs are required to raise physician awareness and implement best practices; only then can the impact of these interventions on FH management and patient outcome be assessed.</p></div

Summary of physicians’ responses to questions about FH knowledge, practice, detection, and awareness.

<p>Summary of physicians’ responses to questions about FH knowledge, practice, detection, and awareness.</p

Summary of physician responses to the most selected risk factors that further increase the CV risk of patients with FH.

<p>Summary of physician responses to the most selected risk factors that further increase the CV risk of patients with FH.</p

Physicians’ demographics (n = 294).

<p>Physicians’ demographics (n = 294).</p

The relationship between FH familiarity and physicians’ demographics.

<p>The relationship between FH familiarity and physicians’ demographics.</p

Familiarity with FH as predicted by physicians' characteristics.

<p>Familiarity with FH as predicted by physicians' characteristics.</p

Mean knowledge score by physicians’ characteristics and FH familiarity.

<p>Mean knowledge score by physicians’ characteristics and FH familiarity.</p

Familial Hypercholesterolemia in the Arabian Gulf Region: Clinical results of the Gulf FH Registry.

Background and aimsFamilial hypercholesterolemia (FH) is a common autosomal dominant disorder that can result in premature atherosclerotic cardiovascular disease (ASCVD). Limited data are available worldwide about the prevalence and management of FH. Here, we aimed to estimate the prevalence and management of patients with FH in five Arabian Gulf countries (Saudi Arabia, Oman, United Arab Emirates, Kuwait, and Bahrain).MethodsThe multicentre, multinational Gulf FH registry included adults (≥18 years old) recruited from outpatient clinics in 14 tertiary-care centres across five Arabian Gulf countries over the last five years. The Gulf FH registry had four phases: 1- screening, 2- classification based on the Dutch Lipid Clinic Network, 3- genetic testing, and 4- follow-up.ResultsAmong 34,366 screened patient records, 3713 patients had suspected FH (mean age: 49±15 years; 52% women) and 306 patients had definite or probable FH. Thus, the estimated FH prevalence was 0.9% (1:112). Treatments included high-intensity statin therapy (34%), ezetimibe (10%), and proprotein convertase subtilisin/kexin type 9 inhibitors (0.4%). Targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol were achieved by 12% and 30%, respectively, of patients at high ASCVD risk, and by 3% and 6%, respectively, of patients at very high ASCVD risk (p ConclusionsThis snap-shot study was the first to show the high estimated prevalence of FH in the Arabian Gulf region (about 3-fold the estimated prevalence worldwide), and is a "call-to-action" for further confirmation in future population studies. The small proportions of patients that achieved target LDL-C values implied that health care policies need to implement nation-wide screening, raise FH awareness, and improve management strategies for FH

Number of hospitals with percutaneous coronary intervention capability (PCI H.) versus without (Non-PCI H.) that enrolled acute STEMI patients in the study per each Arabian Gulf country.

<p>Number of hospitals with percutaneous coronary intervention capability (PCI H.) versus without (Non-PCI H.) that enrolled acute STEMI patients in the study per each Arabian Gulf country.</p

Evidence-based treatments administered in the first 24 hours of hospital admission in acute STEMI patients that arrived to the hospital by an emergency medical service (EMS) versus not (non-EMS).

<p>Other aniplatelets, clopidogrel, prasugrel, ticagrelor; BB, beta-blockers; ACE-I/ARB, angiotensin-converting enzyme inhibitors/Angiotensin-receptor blockers, Heparins, unfractionated or low-molecular weight heparin; GP 2b/3a-I, glycoprotein 2bb/3a inhibitors.</p