Evidence mapPaperPMID 41736064Full record

ArticleBMC health services research2026

FH Genetic Testing in Preventive Cardiology: Unpacking Challenges and Enablers Beyond Cost.

Chaitanyasre Lenin, Frederick H F Chan, Phoebe X H Lim, Gregory Ang, Ashna Nastar, Magdalena Daccord, Emma Print, Sharon Pek, Tavintharan Subramaniam, Konstadina Griva

Abstract read
In one paragraph

Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Chaitanyasre LeninLee Kong Chian School of Medicine, Nanyang Technological University, Level 18, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore.
Frederick H F ChanLee Kong Chian School of Medicine, Nanyang Technological University, Level 18, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore.
Phoebe X H LimLee Kong Chian School of Medicine, Nanyang Technological University, Level 18, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore.
Gregory AngLee Kong Chian School of Medicine, Nanyang Technological University, Level 18, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore.
Ashna NastarDivision of Endocrinology, Alexandra Hospital, Singapore, Singapore.
Magdalena DaccordFH Europe Foundation, Amsterdam, The Netherlands.
Emma PrintFH Europe Foundation, Amsterdam, The Netherlands.
Sharon PekClinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
Tavintharan SubramaniamDiabetes Centre Admiralty Medical Centre, Division of Endocrinology, Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.
Konstadina GrivaLee Kong Chian School of Medicine, Nanyang Technological University, Level 18, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore. konstadina.griva@ntu.edu.sg.

Funding

National Research Foundation, Singapore Ministry of Health, National Medical Research Council, Precision Health Research, Singapore MOH-000588-01
6 · The paper itself

Abstract

importanceFamilial hypercholesterolemia (FH) is a common genetic condition associated with premature cardiovascular disease. Genetic testing enables definitive diagnosis and cascade screening, yet its uptake remains limited even in cost-free settings. As Singapore implements a national subsidized genetic testing service for FH, understanding persisting barriers to testing is critical to improving service design and implementation.

objectiveThis qualitative study examined individual-level barriers and facilitators of genetic testing (GT) uptake and assessed experiences with genetic testing services to inform optimization of services.

designOnline semi-structured interviews explored perceptions of FH, decision-making regarding GT, and experiences with GT services.

setting24 participants recruited from tertiary care and community settings, from August to October 2024, including 11 individuals who had undergone FH GT and 13 who declined or remained undecided. MEASURES: Braun and Clarke’s thematic analysis was applied as a framework to identify major themes related to testing decisions and service experiences, supplemented by team-based coding to examine convergence and divergence across tested and untested subgroups.

resultsBoth tested and untested individuals recognized the personal, familial, and clinical value of GT. Shared facilitators included GT as a tool for definitive diagnosis and identifying family risk, lifestyle motivation, and justification for pursuing medical therapy for their high cholesterol; yet, uptake was undermined by several psychosocial and systemic barriers. Prevalent in both groups was skepticism about the added clinical value of results—especially among individuals already on statins or asymptomatic. Untested participants reported additional distinct concerns related to potential harms (i.e., psychological toll of knowing, social stigma and discrimination, institutional discrimination relating to employment and insurance, and limited information on the testing process and data privacy. Participants who underwent testing reported overall positive service experiences but noted challenges within pre-test procedures (documenting family history, inefficient appointment systems), and post-testing standard of care (long wait for results, heavily technical test result reports). CONCLUSIONS AND RELEVANCE: Even with cost coverage, psychosocial and system-level barriers limit the uptake of FH genetic testing. To realize the full potential of genetic screening in cardiovascular care, implementation strategies must go beyond cost elimination to include patient education, structured care pathways, and sustained provider support. These findings have implications for integrating precision medicine into routine cardiovascular prevention globally.

Indexed as

Cardiovascular DiseasesGenetic TestingHyperlipoproteinemia Type IIAdultFemaleHumansInterviews as TopicMaleMiddle AgedQualitative ResearchSingapore

Identifiers

PMID41736064
PMCPMC13011732

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.