PMID- 25973212
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20150514
LR  - 20210112
IS  - 2053-3624 (Print)
IS  - 2053-3624 (Electronic)
IS  - 2053-3624 (Linking)
VI  - 2
IP  - 1
DP  - 2015
TI  - Impact of clinical follow-up and diagnostic testing on intervention for tetralogy 
      of Fallot.
PG  - e000185
LID - 10.1136/openhrt-2014-000185 [doi]
LID - e000185
AB  - 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.
FAU - House, Aswathy Vaikom
AU  - House AV
AD  - Division of Pediatric Cardiology , University of Nebraska College of Medicine and 
      Children's Hospital and Medical Center , Omaha, Nebraska , USA.
FAU - Danford, David A
AU  - Danford DA
AD  - Division of Pediatric Cardiology , University of Nebraska College of Medicine and 
      Children's Hospital and Medical Center , Omaha, Nebraska , USA.
FAU - Spicer, Robert L
AU  - Spicer RL
AD  - Division of Pediatric Cardiology , University of Nebraska College of Medicine and 
      Children's Hospital and Medical Center , Omaha, Nebraska , USA.
FAU - Kutty, Shelby
AU  - Kutty S
AD  - Division of Pediatric Cardiology , University of Nebraska College of Medicine and 
      Children's Hospital and Medical Center , Omaha, Nebraska , USA.
LA  - eng
PT  - Journal Article
DEP - 20150430
PL  - England
TA  - Open Heart
JT  - Open heart
JID - 101631219
PMC - PMC4422920
OTO - NOTNLM
OT  - CONGENITAL HEART DISEASE
OT  - IMAGING AND DIAGNOSTICS
OT  - QUALITY OF CARE AND OUTCOMES
EDAT- 2015/05/15 06:00
MHDA- 2015/05/15 06:01
PMCR- 2015/04/30
CRDT- 2015/05/15 06:00
PHST- 2014/08/13 00:00 [received]
PHST- 2015/02/03 00:00 [revised]
PHST- 2015/03/04 00:00 [accepted]
PHST- 2015/05/15 06:00 [entrez]
PHST- 2015/05/15 06:00 [pubmed]
PHST- 2015/05/15 06:01 [medline]
PHST- 2015/04/30 00:00 [pmc-release]
AID - openhrt-2014-000185 [pii]
AID - 10.1136/openhrt-2014-000185 [doi]
PST - epublish
SO  - Open Heart. 2015 Apr 30;2(1):e000185. doi: 10.1136/openhrt-2014-000185. 
      eCollection 2015.