Abstract
Cardiopulmonary exercise testing (CPET) is an important tool used in the management of patients with congenital heart disease. However, there are no clear guidelines for its use in specific populations, such as repaired Tetralogy of Fallot (rTOF). We sought to characterize current practice patterns and attitudes regarding exercise testing in the rTOF population using an online survey distributed to pediatric cardiologists. Analyses were performed using qualitative statistics, Wilcoxon rank-sum, Kruskal–Wallis test, and chi-squared analysis. 103 clinicians completed the survey with 83% routinely sending symptomatic rTOF patients for exercise testing and 59% for asymptomatic patients. Respondents who routinely test asymptomatic patients reported higher levels of perceived helpfulness of exercise testing (p < 0.01) and comfort with CPET interpretation (p < 0.01). Although a large majority of respondents found exercise testing to be helpful (81% either “somewhat” or “very” helpful”), a considerably smaller portion indicated comfort with CPET interpretation (49% either “comfortable” or “very comfortable”). Nearly all respondents (92%) reported changing management primarily based on exercise testing results. However, the frequency of changes varied, with 10% “frequently”, 62% “occasionally”, 19% “rarely” changing management. There was a statistically significant relationship between the perceived helpfulness of exercise testing and the likelihood of management changes (p < 0.01). While exercise testing is used to make clinical decisions, our findings suggest that in some cases, management changes may be made without a similar degree of confidence in interpreting CPET findings. The variability in attitudes and practices highlights the need for evidence-based guidelines addressing exercise testing in rTOF, particularly for asymptomatic patients.
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Acknowledgements
The authors would like to acknowledge Matthew’s Hearts of Hope for their support of this work and Ms. Vivian Thorne and the American Academy of Pediatrics: Section on Cardiology and Cardiac Surgery Survey Committee for their assistance with survey development and distribution. The authors would also like to thank the members of the American Academy of Pediatrics: Section on Cardiology and Cardiac Surgery and PediHeartNet for participating in this survey.
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MD and MF created the survey. AL reviewed and edited the survey. MD wrote the main manuscript text and prepared figures. All authors reviewed and edited the manuscript.
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Drastal, M., Layton, A.M. & Fremed, M.A. Characterizing the Use of Exercise Testing in Repaired Tetralogy of Fallot Patients: A Multi-Institutional Survey. Pediatr Cardiol 44, 1821–1830 (2023). https://doi.org/10.1007/s00246-023-03269-9
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DOI: https://doi.org/10.1007/s00246-023-03269-9