New Choosing Wisely guidance addresses Five Things Physicians and Patients Should Question related to pediatric cardiology.
The evidence-based list from the AAP Section on Cardiology and Cardiac Surgery appeals to pediatricians in primary care who face cardiology-related issues in daily practice such as sports exams and electrocardiogram (ECG) orders, said Christopher S. Snyder, M.D., FAAP, chair of the section.
“The list includes vetted and proven recommendations on common complaints and issues. (For example) a lot of people are misinformed about who needs ECGs and echocardiograms. We have yet to identify a study that says every child who participates in sports requires an ECG. These decisions should be deferred to the experts in pediatric cardiology,” he said. “Even during COVID-19, every kid should have a preparticipation examination. Every child who is going to participate in any kind of sports, sixth grade and up, should have a physical exam by a pediatrician or primary care physician.”
The Choosing Wisely list urges pediatricians and patients to keep these five points in mind:
- Do not routinely order a screening ECG as part of a sports preparticipation examination in asymptomatic, otherwise healthy patients with no personal or family history of cardiac disease.
- Do not order a screening ECG prior to initiation of attention-deficit/hyperactivity disorder therapy in asymptomatic, otherwise healthy pediatric patients with no personal or family history of cardiac disease.
- Do not order an echocardiogram for the routine evaluation of pediatric syncope in the absence of a concerning history or ECG abnormalities.
- Do not order an echocardiogram for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities.
- Do not order troponins for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities.
The Choosing Wisely list notes that family history should assess specifically for the following types of cardiovascular diseases: connective tissue disorders, cardiomyopathies, arrhythmias (including the need for a pacemaker or defibrillator implantation), storage diseases, sudden unexplained death and premature cardiovascular disease prior to the age of 50 years.
Choosing Wisely is an initiative of the ABIM Foundation that promotes conversations between clinicians and patients. The AAP has produced several lists that aim to increase value in pediatric care and reduce waste. Find rationale and references behind the pediatric cardiology list and others on the Choosing Wisely Lists of Recommendations webpage, https://www.choosingwisely.org.