Feasibility of novel points-based health questionnaire utilised in a nationwide cardiac screening programme for young individuals
Authors: Maclachlan H , Ambrogetti R , Moulson N , Bhatia R , Fyyaz S , Chatrath N , Androulakis E , Miles C , Basu J , Finocchiaro G , Gati S , Malhotra A , Sharma S , Mckinney J , Papadakis M 
Published: June 2024

Abstract

Background
Widely used cardiac screening protocols in the United States and the United Kingdom include health questionnaires (HQ) with open-ended questions that require an on-site physician to differentiate between symptoms considered benign from pathological, and in turn limit the number of false-positive referrals. The on-site physician is a costly, limited resource and compromises the cost-effectiveness of the screening protocol which in turn limits its application on a large-population scale.

Purpose
The points-based Cardiac Risk in the Young - British Columbia health questionnaire (CRY-BC HQ) was designed to be implemented without an on-site physician and provides a quantitative assessment of cardiovascular symptoms (syncope, chest pain, palpitations, and breathlessness). These symptoms are scored independently of one another using negatively and positively-weighted qualifying statements e.g. Syncope: It occurred very soon after standing up from a seated/lying position [scores -1); Syncope: It occurred during exercise and was not related to head trauma [scores +20]. A score over a pre-determined threshold was considered abnormal, warranting secondary evaluation. The family history component screens for inherited cardiac conditions and young sudden cardiac arrest/death, with any positive response to a first-degree relative considered abnormal, warranting secondary evaluation. We evaluated the effectiveness of the CRY-BC HQ by comparing it to a gold standard – a physician’s interpretation of symptoms and family history reported during a clinical consultation at cardiac screening.

Methods
Over a 6-month period, 10,590 consecutive individuals, aged 14 to 35 years, underwent voluntary cardiac screening as part of Cardiac Risk in the Young's (CRY) nationwide programme. Initial evaluation included the standard CRY HQ (widely used format of questions), 12-lead ECG and a clinical consultation. The consulting physician was blinded to the outcome of the CRY-BC HQ which completed at the same time of the standard CRY HQ.

Results
A total of 5,916 (56%) individuals reported a cardiovascular symptom and/or family history of heart disease on their HQ which required interpretation by the consulting physician. The CRY-BC HQ outcome matched the consulting physician’s interpretation of symptoms for 10,199 (96%) individuals, and family history for 10,548 (99%) individuals. These figures exceed the pre-determined 95% standard and suggests the CRY-BC HQ performs well compared to CRY’s standard practice.

Conclusions
A novel points-based HQ performs effectively compared to an on-site physician’s interpretation of symptoms and family history, indicating potentially significant cost savings in the context of mass screening. Cost savings could be used to screen and identify a greater number of individuals with quiescent cardiac disease. Figure 2- Example question: Syncope.