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Variation in provider compliance with sports restriction guidelines in children with an isolated bicuspid aortic valve

Published online by Cambridge University Press:  06 October 2022

Melissa S.W. Yamauchi Open the ORCID record for Melissa S.W. Yamauchi [Opens in a new window] ,
Michael D. Puchalski ,
Hsin-Yi Weng ,
Nelangi M. Pinto Open the ORCID record for Nelangi M. Pinto [Opens in a new window] ,
Susan P. Etheridge ,
Angela P. Presson ,
L. LuAnn Minich  and
Richard V. Williams
Melissa S.W. Yamauchi*
Affiliation:
Department of Pediatrics, University of Hawaii, Honolulu, HI, USA
Michael D. Puchalski
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, All Children’s Hospital, St Petersburg, FL, USA
Hsin-Yi Weng
Affiliation:
Division of Epidemiology Biostatistics, University of Utah, Salt Lake City, UT, USA
Nelangi M. Pinto
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
Susan P. Etheridge
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
Angela P. Presson
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
L. LuAnn Minich
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
Richard V. Williams
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
*
Author for correspondence: Melissa Yamauchi, M.D. M.P.H., 1319 Punahou Street, Suite 950, Honolulu, HI 96826, USA. Tel: +808-983-8933. E-mail: myamauchi@gmail.com
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Abstract

Background:

Published guidelines for sports restriction for children with a bicuspid aortic valve remain controversial. We sought to describe practice variation and factors influencing sports restrictions in these children.

Methods:

This retrospective single-centre study included children (7–18 years old) with an isolated bicuspid aortic valve at baseline from 1 January, 2005 to 31 December, 2014. Sports restrictions, factors potentially influencing decision-making, and outcomes were collected. Descriptive statistics and multivariable mixed-effects logistic regression models were performed with providers and patients as random effects. Provider variation was estimated using intraclass correlation coefficients. Odds ratios, 95% confidence intervals, and p-values were reported from the models.

Results:

In 565 encounters (253 children; 34 providers), 41% recommended no sports restrictions, 40% recommended high-static and high-dynamic restrictions, and 19% had no documented recommendations. Based on published guidelines, 22% of children were inappropriately restricted while 30% were not appropriately restricted. The paediatric cardiology provider contributed to 37% of observed practice variation (p < 0.001). Sports restriction was associated with older age, males, greater ascending aorta z-score, and shorter follow-up interval. There were no aortic dissections or deaths and one cardiac intervention.

Conclusion:

Physicians frequently fail to document sports restrictions for children with a bicuspid aortic valve, and documented recommendations often conflict with published guidelines. Despite this, no adverse outcomes occurred. Providers accounted for a significant proportion of the variation in sports restrictions. Further research to provide evidence-based guidelines may improve provider compliance with activity recommendations in this population.

Keywords

Bicuspid aortic valvechildrensportsexercise
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 10 , October 2023 , pp. 1813 - 1818
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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