Identifying barriers to genetic testing in subspecialty cardiac care

Abstract

Background The utility of genetic testing in cardiovascular medicine is well-established in expert consensus statements for optimizing patient care. However, significant genetic testing care gaps persist for patients with inherited cardiovascular conditions. Objective This study aimed to understand why genetic testing care gaps in cardiovascular medicine exist by evaluating cardiovascular providers' opinions and use of genetic testing. Methods We developed and administered an anonymous survey to cardiovascular providers delivering direct patient care in the United States. Participants were contacted in collaboration with the Sudden Arrhythmia Death Syndromes (SADS) Foundation. Results A total of 111 individuals completed the survey representing the following specialties: electrophysiology (55%, n=61), general cardiology (10.8%, n=12), imaging (7.2%, n=8), heart failure/transplant (6.3%, n=7), interventional cardiology (6.3%, n=7), fetal cardiology (5.4%, n=6), and other (9%, n=10). Eighty-six percent of respondents (n=97) stated genetic testing is 'very relevant' in the care of their patients. Eighty percent of electrophysiologists reported ordering genetic testing a few times a month or more. Navigating insurance authorization and billing procedures was an identified area of discomfort by 47.7% of respondents (n=53). Overall, cardiovascular provider specialty was shown to impact how often genetic testing is ordered. Provider work setting was shown to impact opinion of the utility of genetic testing for family screening, opinion of the utility of genetic testing for medication and device management, and how often genetic testing is ordered. Conclusions The results of this study support targeted provider education to increase the uptake of genetic testing for patients with inherited cardiovascular conditions.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded by the University of Utah's Graduate Program of Genetic Counseling.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved and granted exemption status by the University of Utah Institutional Review Board (00164238).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon request to the authors.

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