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Contemporary Provider Management Practices and Attitudes Toward Referral for Advanced Heart Failure Therapies in Fontan Patients Across North America.
- Source :
-
Journal of cardiac failure [J Card Fail] 2022 Apr; Vol. 28 (4), pp. 576-587. Date of Electronic Publication: 2021 Dec 09. - Publication Year :
- 2022
-
Abstract
- Background: To date, no reports have described clinicians' management practices for patients with Fontan circulatory failure or their understanding of risk factors for mortality and transplant outcomes in these patients.<br />Methods and Results: A cross-sectional survey of caregivers across North America was conducted from February to September 2020. Responses were compared by primary specialty (heart failure/transplant vs non-heart failure/transplant), years of experience (early, mid, and late career), and Fontan center volume (low, medium, and high). Of 400 responses, the majority were from general cardiologists (111, 28%) followed by heart failure/transplant specialists (93, 23%). Although most agreed that patients with Fontan physiology will have signs/symptoms of heart failure (369 [93%]) and eventuate in heart transplant (286 [72%]), many disagreed (180 [45%]) that routine evaluation by a transplant cardiologist is needed without symptoms. Transplant providers were more likely than non-transplant providers to suggest referral for manifestations of Fontan circulatory failure such as protein-losing enteropathy, plastic bronchitis, liver fibrosis/cirrhosis, and worsening valve regurgitation. Non-transplant providers were more likely to suggest that protein-losing enteropathy, plastic bronchitis, and Fontan-associated liver disease lead to inferior outcomes after transplantation. Early career and transplant providers more favorably viewed ventricular assist device use for Fontan patients failing traditional heart failure therapy (P < .05 for all).<br />Conclusions: There is significant variation in the management of Fontan patients, including heterogeneous timing of referral of such patients to the heart failure/transplant team, which may have implications for future outcomes.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Attitude
Cross-Sectional Studies
Humans
Plastics
Referral and Consultation
Retrospective Studies
Bronchitis complications
Fontan Procedure adverse effects
Heart Defects, Congenital epidemiology
Heart Defects, Congenital surgery
Heart Failure epidemiology
Heart Failure surgery
Heart Transplantation
Protein-Losing Enteropathies etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8414
- Volume :
- 28
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of cardiac failure
- Publication Type :
- Academic Journal
- Accession number :
- 34991953
- Full Text :
- https://doi.org/10.1016/j.cardfail.2021.10.016