Interventional cardiology

Adults with congenital heart disease pose a dilemma for regional cardiologists

Thursday, 22 Nov 2018

Regional cardiology practices see a surprisingly large and diverse range of adults with congenital heart disease and need support networks that include centres of expertise in metropolitan cities, a NSW study finds.

A review by a private cardiology practice in Coffs Harbour found it had seen 101 adults patients with congenital heart disease over three years, including 11 with great complexity such as transposition of the great arteries. A further 24 had disease of moderate complexity such as Tetralogy of fallot and coarctation of the aorta

Most patients had been referred by GPs for surveillance, seven were referred due to pregnancy and eight were new diagnoses.

And since 30% of patients were diagnosed as adults, this suggested a significant proportion of adults with congenital heart disease patients would be “unknown to specialist centres until GPs and regional cardiologists detect abnormalities,” the study authors wrote in in the Australian Journal of Rural Health.

Therefore regional cardiologists should “maintain a high suspicion” of the disease in new patients, they suggested.

This would include incorporating surveillance for legions such as atrial septal defects into routine echocardiography examinations performed at regional cardiology clinics, they said.

The 40% patients with disease of moderate or great complexity would require ongoing reviews by cardiologists with special expertise, who typically work in centres located a long distance from cardiology clinics in regional Australia.

“This confirms the suspected dilemma that regional centres must cater for patients with complex CHD despite resource limitations,” wrote Dr Emily Mary O’Brien, from Coffs Harbour Health Campus and co-authors.

Nine of the patients required had operations for congenital lesions, including seven who had closures for newly diagnosed atrial septal defects.

This highlighted the importance of developing good referral pathways with the close support of outside specialists, the authors said.

Their region had monthly clinics held by visiting specialists from Sydney, but referral pathways were likely to differ between rural and regional areas they said.

“In Townsville and Rockhampton, the current solution has been to use regular adult congenital heart disease outreach programs. Coffs Harbour has a local pulmonary hypertension clinic, enabling PAH to be thoroughly assessed and managed by a specialty team.

Telemedicine was another possible option for rural areas with limited access to specialist centres, they added.

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