Related Experiment Videos
Reliability of reported family history of myocardial infarction
1MONICA Project, Department of Epidemiology and Public Health, Queen's University, Belfast.
Insights
Family history of myocardial infarction (MI) reports are moderately reliable, with good specificity but limited predictive accuracy for screening. While relative risk is estimated well, recall bias affects sibling MI history reports.
Area of Science:
- Cardiology
- Epidemiology
- Genetics
Background:
- Family history of myocardial infarction (MI) is a known risk factor for cardiovascular disease.
- Accurate assessment of family history is crucial for identifying individuals at increased risk.
Purpose of the Study:
- To evaluate the reliability of self-reported family histories of MI.
- To determine the accuracy of reported family histories against validated records.
Main Methods:
- A case-control study involving 200 MI survivors and 200 age-matched controls.
- Validation of reported first-degree relative histories using death certificates, GP records, and hospital notes.
- Assessment of sensitivity, specificity, positive predictive value, and kappa coefficients.
Main Results:
- Reported family histories showed moderate agreement with validated records (kappa 0.65-0.68).
- High specificity (96.5-97.7%) but moderate sensitivity (67.3-68.5%) and positive predictive value (70.5-73.8%) were observed.
- Recall bias was noted for sibling MI histories, with odds ratios of 1.67 for reported and 1.54 for validated histories.
Conclusions:
- Reported family histories of MI have limitations in predictive accuracy for screening programs.
- Despite limitations, reported family history correctly estimates relative risk and can complement genetic testing strategies.
Objective:
To assess the reliability of reported family histories of myocardial infarction.
Design:
A case-control study in which reported histories of first degree relatives were validated from death certificates, general practitioners' records, and hospital notes.
Setting:
Participants enrolled in the Belfast centre of the World Health Organisation's study monitoring trends and determinants in cardiovascular disease (MONICA).
Subjects:
200 men who survived myocardial infarction and 200 age matched controls drawn randomly from the population.
Main Outcome Measures:
The sensitivity, specificity, positive predictive value, and proportion of overall agreement with validated records of reported family histories of myocardial infarction in first degree relatives; odds ratios for myocardial infarction, given at least one reported relative or at least one verified relative being affected.
Results:
349 of the 400 probands provided detailed family histories, reporting on 2812 first degree relatives. The overall sensitivity, specificity, and positive predictive value of reported histories were 67.3%, 96.5%, and 70.5% for cases and 68.5%, 97.7%, and 73.8% for controls. The kappa coefficients were modest: 0.65 for cases and 0.68 for controls. The odds ratios for myocardial infarction, given at least one affected relative, were not substantially inflated by recall bias. Some recall bias was evident for the probands' reports of their siblings' histories of myocardial infarction, the odds ratio for a reported history being 1.67 (95% confidence interval 1.09 to 2.57) and for the validated history 1.54 (1.01 to 2.37).
Conclusions:
Although the relative risk of disease is correctly estimated, the predictive accuracy of a casual family history of myocardial infarction may limit the effectiveness of targeted screening programmes. They may, however, complement other strategies based on genetic testing.