Top Things to Know: Towards a Roadmap for Best Practices in Pediatric Preventive Cardiology
Published: August 07, 2023
- Pediatric preventive cardiology (PPC) programs address key cardiovascular disease (CVD) risk factors such as lipid disorders and hypertension in youth, thereby reducing their risk of premature death from CVD. Unfortunately, demand exceeds supply: according to our survey of PPC programs across the U.S. and Canada, wait times are >3 months in 35% of PPC programs, and, at large centers, 53% of programs are overwhelmed with referrals.
- More PPC clinicians are needed, and the pipeline for the next generation of PPC specialists is limited. The full-time-equivalent (FTE) effort devoted to PPC by preventive cardiologists is low at 0.2 FTE (range 0.2-1.2), and only 2 of 41 responding programs offer formal PPC fellowship training.
- Pediatric cardiology division directors find great value in PPC programs. There was near universal (96%) agreement that PPC programs fulfill critical roles, such as for public health, community outreach, advocacy, and engagement, and divisional or departmental missions.
- Although pediatric cardiology division directors value PPC programs, gaps exist between needed and available resources. Division directors deem social workers and psychologists as key PPC team members, but few existing PPC teams include them.
- PPC clinicians are eager to collaborate to share best practices and reduce practice variation. They identify the need for updated pediatric CVD prevention guidelines, last updated in 2011, as the #1 priority for the field. Specific high-priority evidence gaps were named for the treatment of dyslipidemia and hypertension and optimal implementation of lifestyle behavior change.
- Policymakers, payers, hospitals, and heart centers are called upon to invest resources into PPC programs and patients, including support to address psychosocial and behavioral challenges, commensurate with the high burden of CVD risk in our youth.
- Professional societies and foundations are urged to advocate for PPC programs and to support PPC education/training and opportunities for PPC program networking and collaborations.
- Funders and researchers are asked to fund/conduct research that would have major impacts for PPC, including clinical trials focused on pediatric dyslipidemia and hypertension, studies of novel care models, and implementation research for lifestyle interventions in diverse pediatric populations.
- PPC clinicians are invited to join forces to advance best practices and to innovate as part of research teams.
- Key next steps will include a comprehensive evidence review, the generation of updated guidelines and standards, and the development of a strategic action plan to advance PPC care.
Citation
Perak AM, Baker-Smith C, Hayman LL, Khoury M, Peterson AL, Ware AL, Zachariah JP, Raghuveer G; on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing; and Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Toward a roadmap for bestpractices in pediatric preventive cardiology: a science advisory from the American Heart Association [published online ahead of print August 7, 2023]. Circ Cardiovasc Qual Outcomes. doi: 10.1161/HCQ.0000000000000120