Abstract
Background: The impact of the 2007 American Heart Association endocarditis prophylaxis guidelines on clinician practice has not been well established. Our objective was to evaluate how the American Heart Association endocarditis guidelines changed the practice of cardiologists who manage congenital heart disease and to ascertain the degree of practice variation among cardiologists. Methods: A cross-sectional Web-based survey was e-mailed to Canadian (n = 134), Australian (n = 33), New Zealand (n = 9), and a random sample of American (n = 250) pediatric and adult congenital heart disease cardiologists in 2008. Nonrespondents received the survey 4 times by e-mail and once by regular post. Results: The response rate was 55%. The lesions for which cardiologists were most evenly divided between recommending versus not recommending prophylaxis were "rheumatic mitral stenosis of moderate severity" (45% recommended prophylaxis) and "perimembranous ventricular septal defect (VSD) status post surgical patch closure with no residual shunt 3 months post- operatively" (54% recommended prophylaxis). The lesions for which the greatest proportion of cardiologists discontinued prophylaxis were "small muscular VSD, no previous endocarditis" (80% discontinued prophylaxis) and "small audible patent ductus arteriosus" (83% discontinued prophylaxis). Only 69% recommended prophylaxis for "VSD s/p surgical patch closure with small residual shunt" despite current guidelines recommending prophylaxis for this scenario. Twenty-eight percent of respondents felt that the new guidelines leave some patients at risk, and 6% would not recounsel any low-risk patients following these guidelines. Conclusions: The 2007 guidelines have resulted in a substantial change in endocarditis prophylaxis. There remains considerable heterogeneity among cardiologists regarding the prophylaxis of certain cardiac lesions.
| Original language | English |
|---|---|
| Pages (from-to) | 123-129 |
| Number of pages | 7 |
| Journal | American Heart Journal |
| Volume | 161 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2011 |
| Externally published | Yes |
Bibliographical note
Funding Information:Study participants were contacted and informed about the survey using electronic mail. Nonresponders were e-mailed up to 4 times, with a 2-week interval between each. Continued nonresponders received a paper copy of the survey with a self-addressed, stamped envelope. Surveys were distributed from March to July 2008 to American cardiologists, from March to June 2008 to Canadian cardiologists, and from June to December 2008 to Australian and New Zealander cardiologists. Respondents were given the option of providing their contact information and receiving a $10 coffee card honorarium (in respective countries' currencies) to reimburse them for their time. Return of a completed survey was taken as implied consent. All responses were anonymous, with no link possible between responses and e-mail addresses or other personal identifying information. This study was funded by the Stollery Children's Hospital Foundation and approved by the Health Research Ethics Board at the University of Alberta.
ASJC Scopus Subject Areas
- Cardiology and Cardiovascular Medicine