American Heart Month: Four Things to Do as a Genetic Counselor

February is American Heart Month! This entire month is dedicated to bringing awareness to the leading cause of death in the United States – heart disease. From coronary artery disease to congenital heart disease, it is not uncommon for genetic counselors to uncover some type of cardiac history while they are working with their patients and families. As part of American Heart Month, I encourage all genetic counselors to consider how they approach patients and families with cardiac disease, and how they can incorporate cardiac awareness into their practice. Here are four things to keep in mind, even when Heart Month is over.

1. Know the red flags in family histories.

Not all cardiac concerns reported by patients and families are necessarily signs of an inherited cardiac condition. If you do have a patient who reports any of the following, further evaluation may be warranted:

• Unexplained cardiac arrest or death
• Heart disease at young ages (women less than 65 years and men less than 55 years)
• Untreated LDL greater than or equal to 190
• Exercise intolerance
• Heart failure or heart transplant at a young age ( less than 60 years)
• Enlarged heart or cardiomyopathy
• Individuals with an ICD or pacemaker placed at a young age (less than 50 years)
• Aortic aneurysm/dissection at a young age (less than 50 years), especially thoracic
• Multiple individuals in the family born with a heart defect
• Sudden infant death syndrome

While not a comprehensive list, this should provide you with a good foundation of indications to prompt further discussion and evaluation. Never be afraid to ask too many questions of your patients to help clarify details! If you want an easy guide to keep by your side, I highly recommend the NSGC Cardiovascular Genetics Pocket Guide.

2. Have a good set of cardiac resources in your back pocket.

Sometimes a cardiac family history can surprise you when you least expect it. So, be prepared with resources to share or use during chart prep!

• If your patient wants a comprehensive genetic testing overview handout, share this patient-friend article published in JAMA Cardiology (PMID: 31365019).¹
• Have a list of websites with reliable information for all types of cardiac disease!
  • American Heart Association
  • Centers for Disease Control and Prevention – Heart Disease
  • The FH Foundation
  • The SADS Foundation
  • Children’s Cardiomyopathy Foundation
  • DCM Foundation
  • HCM Association
• Utilize available guidelines and scientific statements for these cardiac conditions.
  • Congenital heart disease²
  • Dyslipidemia³
  • Cardiomyopathy⁴
  • Arrhythmia⁵

3. Always know that cardiovascular genetic counselors are happy to help you with whatever you need!

Whenever you need additional support or need a sounding board for a particular case, you can always reach out to genetic counselors who specialize in cardiovascular genetics. In Ohio, we have many cardiovascular genetic counselors who are eager to discuss any of your cardio-related needs. If you are looking to get more involved with cardiovascular genetics yourself, join NSGC’s Cardiovascular SIG and gain access to helpful resources, informative webinars, and lively discussion through the discussion board.

4. While it may not be required to practice as a genetic counselor… Learn CPR!

According to the American Heart Association, 38.3% of sudden cardiac arrest events that happen outside of a hospital were witnessed by a layperson. Only 12.7% were witnessed by an EMS provider.⁶ In the event of sudden cardiac arrest, immediately initiating cardiopulmonary resuscitation (CPR) can significantly increase the chances of survival! If your employer offers CPR training, enlist your fellow GCs (and other co-workers who may typically not be CPR-certified) to take a class together. The American Heart Association website offers a search tool to find classes near you if not offered through your employer. Sign up today and be prepared in case of emergency!

How will you celebrate Heart Month?

Outside of your professional role, you can honor Heart Month by participating in activities like wearing red throughout the month and on National Wear Red Day (February 5th), starting a walking club with your neighbors (socially distanced, of course), or making your favorite heart-health meal for dinner.

Professionally and independently, genetic counselors from all specialties play an integral role in increasing awareness of inherited cardiac disease. Share how you are celebrating American Heart Month as an Ohio GC by using #OhioGeneticsHeartMonth!

References

1. Moscarello T, Reuter C, Ashley EA. Is Genetic Testing for Heart Disease Right for Me? JAMA Cardiol. 2019 Sep 1;4(9):956. doi: 10.1001/jamacardio.2019.2421. PMID: 31365019.
2. Pierpont ME, Brueckner M, Chung WK, Garg V, Lacro RV, McGuire AL, Mital S, Priest JR, Pu WT, Roberts A, Ware SM, Gelb BD, Russell MW; American Heart Association Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Genomic and Precision Medicine. Genetic Basis for Congenital Heart Disease: Revisited: A Scientific Statement From the American Heart Association. Circulation. 2018 Nov 20;138(21):e653-e711. doi: 10.1161/CIR.0000000000000606. Erratum in: Circulation. 2018 Nov 20;138(21):e713. PMID: 30571578; PMCID: PMC6555769.
3. Brown EE, Sturm AC, Cuchel M, Braun LT, Duell PB, Underberg JA, Jacobson TA, Hegele RA. Genetic testing in dyslipidemia: A scientific statement from the National Lipid Association. J Clin Lipidol. 2020 Jul-Aug;14(4):398-413. doi: 10.1016/j.jacl.2020.04.011. Epub 2020 May 7. PMID: 32507592.
4. Hershberger RE, Givertz MM, Ho CY, Judge DP, Kantor PF, McBride KL, Morales A, Taylor MRG, Vatta M, Ware SM. Genetic Evaluation of Cardiomyopathy-A Heart Failure Society of America Practice Guideline. J Card Fail. 2018 May;24(5):281-302. doi: 10.1016/j.cardfail.2018.03.004. Epub 2018 Mar 19. PMID: 29567486.
5. Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Heart Rhythm. 2013 Dec;10(12):e85-108. doi: 10.1016/j.hrthm.2013.07.021. Epub 2013 Jul 31. PMID: 23916535.
6. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021 Jan 27:CIR0000000000000950. doi: 10.1161/CIR.0000000000000950. Epub ahead of print. PMID: 33501848.