Motivos y complicaciones relacionadas con el rechazo de pruebas diagnósticas y recomendaciones terapéuticas en cardiopatías familiares. Estudio RELUCTANT / Reasons for refusing diagnostic tests and therapeutic recommendations and associated complications in inherited heart diseases. The RELUCTANT study

Introducción y objetivos: El estudio de las cardiopatías familiares implica realizar pruebas diagnósticas, a veces molestas, a familiares asintomáticos. El objetivo de este proyecto es cuantificar el rechazo a dichas pruebas y recomendaciones terapéuticas. Métodos: Se evaluó a 1.992 familias consecutivas con cardiopatías familiares para analizar el rechazo al cribado familiar. Se evaluó a 1.539 (recomendación de cardiorresonancia) y 837 (recomendación de test de provocación farmacológica). Se evaluó a 395 pacientes con indicación de desfibrilador automático implantable (DAI) y 402 con indicación de anticoagulación, para estudiar el rechazo de los tratamientos. Resultados: El 28% de las familias a las que se recomienda estudio por sospecha de cardiopatía familiar no acuden; el rechazo es menor si hay antecedentes familiares de muerte súbita. El 23% no se sometió a la resonancia; los 2 motivos más alegados son citación imposible (53%) y claustrofobia (18%). Las personas de más edad, las mujeres, los sintomáticos, los individuos con arritmias y los familiares rechazaron más la prueba. El 19% no se hizo el test de provocación farmacológica por temor (46%) o citación imposible (25%). Los individuos de más edad, los asintomáticos, aquellos con antecedente de arritmias, los familiares y aquellos con estudio genético positivo lo rechazaron en mayor proporción. Solo una minoría de pacientes rechazaron los tratamientos (el 5,1% el DAI y el 2,5% la anticoagulación). La tasa de muerte súbita entre los que rechazaron el DAI fue alta (el 4,5% al año). Conclusiones: Una quinta parte de las personas que acuden al cribado de cardiopatías familiares rechazan la realización de pruebas más sofisticadas y molestas. Se identifican varios predictores independientes asociados con el rechazo. Solo una minoría de pacientes en alto riesgo rechazan los tratamientos como la anticoagulación o el implante de DAI. (AU)

Introduction and objectives: Study of inherited heart diseases (IHD) involves performing diagnostic tests, which are sometimes inconvenient or stressful, in asymptomatic relatives. The aim of this study was to analyze refusal to undergo various diagnostic tests and follow therapeutic recommendations. Methods: We assessed 1992 consecutive families with IHD to analyze refusal to undergo family screening. The study included 1539 individuals who were recommended to undergo cardiac magnetic resonance, and 837 who were recommended a drug challenge test. To study treatment refusal, we assessed 395 patients with an indication for an implantable cardioverter-defibrillator (ICD) and 402 patients with an indication for anticoagulation. Results: A total of 28% of families who were recommended to undergo screening for suspected IHD did not attend, but refusal was lower if there was a family history of sudden cardiac death. In all, 23% did not undergo magnetic resonance, and the 2 main reasons were administrative problems (53%) and claustrophobia (18%). Refusal was more common in older people, women, symptomatic persons, individuals with arrhythmias, and relatives. Nearly one fifth (19%) did not take the drug challenge test, due to fear (46%) or administrative issues (25%). Refusal was more frequent in older individuals, asymptomatic persons, those with a history of arrhythmias, relatives, and those with a positive genetic study. Only a minority of patients rejected the treatments (5.1% ICD, 2.5% anticoagulation). The percentage of sudden cardiac death in persons rejecting ICD implantation was high (4.5% per year). Conclusions: One fifth of people attending screening for IHD refused to undergo more sophisticated and stressful tests. This study identified several independent predictors associated with refusal. Only a minority of high-risk patients refused treatments such as ICD implantation and anticoagulation. (AU)

Reasons for refusing diagnostic tests and therapeutic recommendations and associated complications in inherited heart diseases. The RELUCTANT study.

INTRODUCTION AND OBJECTIVES: Study of inherited heart diseases (IHD) involves performing diagnostic tests, which are sometimes inconvenient or stressful, in asymptomatic relatives. The aim of this study was to analyze refusal to undergo various diagnostic tests and follow therapeutic recommendations. METHODS: We assessed 1992 consecutive families with IHD to analyze refusal to undergo family screening. The study included 1539 individuals who were recommended to undergo cardiac magnetic resonance, and 837 who were recommended a drug challenge test. To study treatment refusal, we assessed 395 patients with an indication for an implantable cardioverter-defibrillator (ICD) and 402 patients with an indication for anticoagulation. RESULTS: A total of 28% of families who were recommended to undergo screening for suspected IHD did not attend, but refusal was lower if there was a family history of sudden cardiac death. In all, 23% did not undergo magnetic resonance, and the 2 main reasons were administrative problems (53%) and claustrophobia (18%). Refusal was more common in older people, women, symptomatic persons, individuals with arrhythmias, and relatives. Nearly one fifth (19%) did not take the drug challenge test, due to fear (46%) or administrative issues (25%). Refusal was more frequent in older individuals, asymptomatic persons, those with a history of arrhythmias, relatives, and those with a positive genetic study. Only a minority of patients rejected the treatments (5.1% ICD, 2.5% anticoagulation). The percentage of sudden cardiac death in persons rejecting ICD implantation was high (4.5% per year). CONCLUSIONS: One fifth of people attending screening for IHD refused to undergo more sophisticated and stressful tests. This study identified several independent predictors associated with refusal. Only a minority of high-risk patients refused treatments such as ICD implantation and anticoagulation.