Open Access Study protocol

Realising the potential of the family history in risk assessment and primary prevention of coronary heart disease in primary care: ADDFAM study protocol

Nadeem Qureshi1*, Sarah Armstrong2, Paula Saukko3, Tracey Sach4, Jo Middlemass5, Phil H Evans6, Joe Kai1, Hannah Farrimond7 and Steve E Humphries8

Author Affiliations

1 Division of Primary Care, University of Nottingham, Nottingham, UK

2 Trent Research and Development Support Unit, University of Nottingham, Nottingham, UK

3 Department of Social Sciences, Loughborough University, Loughborough, UK

4 School of Chemical Sciences and Pharmacy, University of East Anglia, Norwich, UK

5 Research and Development Department, Nottinghamshire County Teaching Primary Care Trust, Nottingham, UK

6 Peninsula Medical School, Universities of Exeter and Plymouth, UK

7 EGENIS (ESRC Centre for Genomics in Society), University of Exeter, Exeter, UK

8 Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Royal Free and University College London Medical School, London, UK

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BMC Health Services Research 2009, 9:184  doi:10.1186/1472-6963-9-184

Published: 12 October 2009



Coronary heart disease (CHD) is the leading cause of death in the developed world, and its prevention a core activity in current UK general practice. Currently, family history is not systematically integrated into cardiovascular risk assessment in the UK, Europe or the US. Further, primary health care professionals' lack the confidence to interpret family history information and there is a low level of recording of family history information in General Practice (GP) records. Primary prevention of CHD through lifestyle advice has sometimes yielded modest results although, for example, behavioural interventions targeted at "at risk" patients have produced encouraging findings. A family history approach, targeted at those requesting CHD assessment, could motivate lifestyle change. The project will assess the clinical value of incorporating systematic family history information into CHD risk assessment in primary care, from the perspective of the users of this service, the health care practitioners providing this service, and the National Health Service.


The study will include three distinct phases: (1) cross-sectional survey to ascertain baseline information on current recording of family information; (2) through an exploratory matched-pair cluster randomised study, with nested qualitative semi-structured interview and focus group study, to assess the impact of systematic family history recording on participants' and primary care professionals' experience; (3) develop an economic model of the costs and benefits of incorporating family history into CHD risk assessment.


On completion of the project, users and primary care practitioners will be more informed of the value and utility of including family history in CHD risk assessment. Further, this approach will also act as a model of how familial risk information can be integrated within mainstream primary care preventive services for common chronic diseases.

Trial Registration

Current Controlled Trials ISRCTN17943542