There are insufficient resources available to meet the needs for pediatric preventive cardiology care

More adolescents and teenagers are developing health conditions that may increase the risk of premature cardiovascular disease in adulthood, so early screening, diagnosis and multidisciplinary care are vital. A new study of cardiovascular care centers in the U.S. and Canada found insufficient resources to meet pediatric preventive cardiac care needs, and the study’s findings are detailed in a new American Heart Association scientific advisory published today in the association’s journal Circulation : cardiovascular quality and outcomes.

The advisory board is the first to examine the state of pediatric preventive cardiology (PPC) programs in the US and Canada and presents a road map for the future of the field.

It reports that 39% of US youth ages 12-19 are diagnosed as overweight or obese, 53% have abnormal lipids, 18% have prediabetes, and 15% have high blood pressure. Children with these conditions have an increased risk of heart attack or stroke by the time they reach their 40s or 50s, according to previous research.

Risk factors for cardiovascular disease beginning in childhood have important consequences for health, quality of life, health care costs, and costs to society throughout life.”

Amanda Marma Perak, MD, MS, FAHA, Scientific Writing Advisory Committee Chair and Assistant Professor of Pediatrics (Cardiology) and Preventive Medicine at Northwestern University Chicago Feinberg School of Medicine

PPC programs have been independently established in the United States and Canada to address risk factors for cardiovascular disease before adulthood and prevent the development of cardiovascular disease. Unfortunately, many programs report being overwhelmed with referrals and have long wait times for appointments. Clinicians also reported the need for updated guidelines for the treatment of cardiovascular risk factors in young people to ensure consistency of care.

To assess the current state of pediatric preventive cardiology, the advisory writing committee surveyed two groups of health professionals. One study was of directors of pediatric cardiology departments in university hospitals; the survey included questions about practice characteristics and personal opinions about the needs and logistics of the PPC program. These hospital division programs were classified as small, medium, and large based on the number of heart surgeries performed annually. The second study targeted lead clinicians in PPC programs in the United States and Canada, whether in a university setting or not. They were asked about current practices in the program, including the types of health professionals who are part of the team, therapies provided, and future plans. The writing group received and analyzed responses from 53 department directors and 41 clinician managers.

The survey among directors of pediatric cardiology departments revealed:

• Dedicated PPC programs were established in 65% of large pediatric cardiology units, 61% of medium units, and 17% of small units.
• The majority of respondents valued the programs, particularly for improving public health, managing patient volume, and helping to generate research funding.
• They largely agreed that PPC programs should provide care for children and teenagers with lipid disorders, high blood pressure, obesity, or a family history of premature heart disease.
• When asked about staffing, most directors responded that staffing for a PPC program should include a preventive cardiologist, a registered dietitian, a nurse practitioner or physician assistant, and a registered dietitian.
  • About half approved of a psychologist or behavioral therapist being part of the PPC team, and 3 in 4 suggested a social worker be included.
  • About one-third responded that a genetic counselor, forensic specialist, administrative assistant, or research assistant should also be part of the PPC team.

The survey of PPC leading clinicians revealed:

• Demand outstrips supply, with appointment wait times of 3 months or more in a third of PPC programs.
• While 37% of PPC clinicians are actively trying to build their programs, 34% report being overwhelmed with new patient referrals/referrals.
• Despite the need for more PPC professionals, training opportunities are limited, with only 2 of 41 programs offering fellowship training.

“These findings highlight resource challenges, even when everyone believes that certain practices can be beneficial,” said Perak, who is also an attending cardiologist at Ann & Robert H. Lurie Children’s Hospital in Chicago.

The advisory board suggests that policymakers, payers, hospitals, and heart centers should invest resources in PPC programs, including support for psychosocial and behavioral care.

Among the predefined options for prioritizing the most urgent needs, the new practice guidelines were ranked as the highest or high priority by 4 out of 5 PPC clinicians. In their written responses, PPC clinicians appeared eager to collaborate on best practices and ways to reduce practice variation between clinics.

The Advisory Council calls upon professional societies and foundations to advocate for PPC programs and to support PPC education, training, and networking and collaboration opportunities. The writing group is calling for new research to fill gaps in evidence about how best to prevent heart disease and stroke in children with risk factors, especially those with high blood pressure and high cholesterol. They also identify the need to study new ways to deliver care and how to effectively implement lifestyle interventions in racially and economically diverse pediatric populations. The American Heart Association’s Young Hearts Council will explore opportunities to address and support these needs.

“Based on these findings, our hope is that health systems and policymakers will be motivated to reconsider how resources can be redirected to better support this priority area among high-risk youth before cardiovascular disease develops.” , Perak said.

According to the consultation, key next steps include a comprehensive review of the evidence, updated guidelines and standards and the development of a strategic action plan to advance PPC care.

American Heart Association Scientific Councils evaluate potential new areas of cardiovascular care and can outline what is currently known about a topic, which areas need further research, and suggest improvements. While scientific advice and scientific statements inform the development of guidelines, they do not make treatment recommendations. The advice was prepared on behalf of the Council on Hypertension of the American Heart Association; Cardiovascular and Stroke Nursing Council; and the Council on Congenital Heart Disease and Young Hearts (Young Hearts).