Paediatric cardiologist adherence to American Heart Association neurodevelopmental recommendations for CHD patients

Abstract

A 2012 American Heart Association statement concluded that children with CHD are at an increased risk for neurodevelopmental delays. Routine surveillance and evaluation throughout childhood are recommended. To assess paediatric cardiologist compliance with American Heart Association guidelines and developmental referral practices, a survey was distributed to paediatric cardiologists nationwide (n = 129). The majority of participants (69%) stated they were somewhat familiar or not familiar with the American Heart Association statement and were concerned about patients not being properly referred to specialists for developmental evaluation. Forty paediatric cardiologists (31%) indicated that their institution did not have a neurodevelopmental cardiology programme. Of these, 25% indicated they generally did not refer CHD patients for neurodevelopmental evaluation, 45% performed surveillance and referred if warranted, and 30% generally referred all patients for surveillance. Lastly, 43% of paediatric cardiologists did not feel responsible for developmental surveillance, and 11% did not feel responsible for referrals. To ensure all children with CHD are appropriately screened and referred, paediatricians and cardiologists must work together to address differing impressions of accountability for surveillance and screening of children with CHD.

Implementing neurodevelopmental follow‐up care for children with congenital heart disease: A scoping review with evidence mapping

“…Additionally, in one survey of paediatricians and family physicians, 9 only half routinely referred children with CHD for formal developmental evaluation. Similarly, in another survey, 55 only 45% of paediatric cardiologists without access to a developmental follow‐up programme routinely performed neurodevelopmental surveillance. Consequently, authors of these surveys perceived care to be suboptimal, and concluded that many high‐risk children did not seem to be receiving appropriate care to meet their developmental needs.…”

“…Full‐text screening of these 193 publications resulted in 35 publications being included in this review. 9 , 13 , 14 , 15 , 16 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 The stages of the search and screening process and reasons for exclusion are presented in the PRISMA‐ScR flow diagram (Figure S1 ).…”

“…Of these, 21 studies examined the implementation of specific programmes or care pathways for neurodevelopmental follow‐up care, 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 42 , 44 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 and 12 studies reported on surveys or overviews of current clinical practices in neurodevelopmental follow‐up. 9 , 13 , 14 , 15 , 16 , 30 , 37 , 41 , 43 , 45 , 46 , 55 …”

“…Fifteen studies 13 , 14 , 15 , 27 , 32 , 34 , 35 , 36 , 38 , 40 , 42 , 43 , 46 , 53 , 55 identified one or more factors that influenced the implementation of neurodevelopmental follow‐up care practices for children with CHD. We classified these as either barriers or enablers to implementation at the level of the patient, organization/hospital, or local context (Figure 2 ).…”

“…Of these, 21 studies examined the implementation of specific programmes or care pathways for neurodevelopmental follow-up care, [27][28][29][31][32][33][34][35][36][38][39][40]42,44,[47][48][49][50][51][52][53][54]56 and 12 studies reported on surveys or overviews of current clinical practices in neurodevelopmental follow-up. 9,[13][14][15][16]30,37,41,43,45,46,55 Implementation and evaluation of follow-up programmes or care pathways All studies were published after 2011, with most (15 out of 21) conducted since 2018. Fourteen of the studies reported on neurodevelopmental care pathways or programmes based in the USA, 27,[32][33][34][35][36][38][39][40]42,44,[46]…”