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Impact of clinical follow-up and diagnostic testing on intervention for tetralogy of Fallot

OBJECTIVE: Our purpose was to evaluate yield of tools commonly advocated for surveillance of tetralogy of Fallot (TOF). METHODS: All patients (pts) with TOF, seen at any time from 1/2008 to 9/2013 in an academic cardiology practice were studied. At the first and each subsequent outpatient visit, the...

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Autores principales: House, Aswathy Vaikom, Danford, David A, Spicer, Robert L, Kutty, Shelby
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422920/
https://www.ncbi.nlm.nih.gov/pubmed/25973212
http://dx.doi.org/10.1136/openhrt-2014-000185
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author House, Aswathy Vaikom
Danford, David A
Spicer, Robert L
Kutty, Shelby
author_facet House, Aswathy Vaikom
Danford, David A
Spicer, Robert L
Kutty, Shelby
author_sort House, Aswathy Vaikom
collection PubMed
description OBJECTIVE: Our purpose was to evaluate yield of tools commonly advocated for surveillance of tetralogy of Fallot (TOF). METHODS: All patients (pts) with TOF, seen at any time from 1/2008 to 9/2013 in an academic cardiology practice were studied. At the first and each subsequent outpatient visit, the use of tools including history and physical (H&P), ECG, Holter (HOL), echocardiogram (Echo), MR or CT (MR-CT) and stress testing (STR) were noted. Recommendations for intervention (INT) and for time to next follow-up were recorded; rationale for each INT with attribution to one or more tools was identified. RESULTS: There were 213 pts (mean 11.5 years, 130 male) who had 916 visits, 123 of which (13.4%) were associated with 138 INTs (47 surgical, 54 catheter-mediated, 37 other medical). Recommended follow-up interval was 9.44±6.5 months, actual mean follow-up interval was 11.7 months. All 916 (100%) patient visits had a H&P which contributed to 47.2% of INT decisions. Echo was performed in 652 (71.2%) of visits, and contributed to 53.7% of INTs. MR-CT was obtained in 129 (14.1%) of visits, and contributed to 30.1% of INTs. ECG was applied in 137 (15%) visits, and contributed to 1.6% of INTs. HOL was obtained in 188 (20.5%) visits, and contributed to 11.3% of INTs. STR was performed at 101 (11%) of visits, and contributed to 8.9% of INTs. CONCLUSIONS: INTs are common in repaired TOF, but when visits average every 11–12 months, most visits do not result in INT. H&P, Echo and HOL were the most frequently applied screens, and all frequently yielded relevant information to guide INT decisions. STR and MR/CT were applied as targeted testing and in this limited, non-screening role had high relevance for INT. There was low utilisation of ECG and major impact on INT was not demonstrated. Risk stratification in TOF may be possible, and could result in more efficient surveillance and targeted testing.
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spelling pubmed-44229202015-05-13 Impact of clinical follow-up and diagnostic testing on intervention for tetralogy of Fallot House, Aswathy Vaikom Danford, David A Spicer, Robert L Kutty, Shelby Open Heart Congenital Heart Disease OBJECTIVE: Our purpose was to evaluate yield of tools commonly advocated for surveillance of tetralogy of Fallot (TOF). METHODS: All patients (pts) with TOF, seen at any time from 1/2008 to 9/2013 in an academic cardiology practice were studied. At the first and each subsequent outpatient visit, the use of tools including history and physical (H&P), ECG, Holter (HOL), echocardiogram (Echo), MR or CT (MR-CT) and stress testing (STR) were noted. Recommendations for intervention (INT) and for time to next follow-up were recorded; rationale for each INT with attribution to one or more tools was identified. RESULTS: There were 213 pts (mean 11.5 years, 130 male) who had 916 visits, 123 of which (13.4%) were associated with 138 INTs (47 surgical, 54 catheter-mediated, 37 other medical). Recommended follow-up interval was 9.44±6.5 months, actual mean follow-up interval was 11.7 months. All 916 (100%) patient visits had a H&P which contributed to 47.2% of INT decisions. Echo was performed in 652 (71.2%) of visits, and contributed to 53.7% of INTs. MR-CT was obtained in 129 (14.1%) of visits, and contributed to 30.1% of INTs. ECG was applied in 137 (15%) visits, and contributed to 1.6% of INTs. HOL was obtained in 188 (20.5%) visits, and contributed to 11.3% of INTs. STR was performed at 101 (11%) of visits, and contributed to 8.9% of INTs. CONCLUSIONS: INTs are common in repaired TOF, but when visits average every 11–12 months, most visits do not result in INT. H&P, Echo and HOL were the most frequently applied screens, and all frequently yielded relevant information to guide INT decisions. STR and MR/CT were applied as targeted testing and in this limited, non-screening role had high relevance for INT. There was low utilisation of ECG and major impact on INT was not demonstrated. Risk stratification in TOF may be possible, and could result in more efficient surveillance and targeted testing. BMJ Publishing Group 2015-04-30 /pmc/articles/PMC4422920/ /pubmed/25973212 http://dx.doi.org/10.1136/openhrt-2014-000185 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Congenital Heart Disease
House, Aswathy Vaikom
Danford, David A
Spicer, Robert L
Kutty, Shelby
Impact of clinical follow-up and diagnostic testing on intervention for tetralogy of Fallot
title Impact of clinical follow-up and diagnostic testing on intervention for tetralogy of Fallot
title_full Impact of clinical follow-up and diagnostic testing on intervention for tetralogy of Fallot
title_fullStr Impact of clinical follow-up and diagnostic testing on intervention for tetralogy of Fallot
title_full_unstemmed Impact of clinical follow-up and diagnostic testing on intervention for tetralogy of Fallot
title_short Impact of clinical follow-up and diagnostic testing on intervention for tetralogy of Fallot
title_sort impact of clinical follow-up and diagnostic testing on intervention for tetralogy of fallot
topic Congenital Heart Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422920/
https://www.ncbi.nlm.nih.gov/pubmed/25973212
http://dx.doi.org/10.1136/openhrt-2014-000185
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