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Variation in provider compliance with sports restriction guidelines in children with an isolated bicuspid aortic valve

Published online by Cambridge University Press:  06 October 2022

Melissa S.W. Yamauchi*
Affiliation:
Department of Pediatrics, University of Hawaii, Honolulu, HI, USA
Michael D. Puchalski
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, All Children’s Hospital, St Petersburg, FL, USA
Hsin-Yi Weng
Affiliation:
Division of Epidemiology Biostatistics, University of Utah, Salt Lake City, UT, USA
Nelangi M. Pinto
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
Susan P. Etheridge
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
Angela P. Presson
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
L. LuAnn Minich
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
Richard V. Williams
Affiliation:
Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
*
Author for correspondence: Melissa Yamauchi, M.D. M.P.H., 1319 Punahou Street, Suite 950, Honolulu, HI 96826, USA. Tel: +808-983-8933. E-mail: myamauchi@gmail.com

Abstract

Background:

Published guidelines for sports restriction for children with a bicuspid aortic valve remain controversial. We sought to describe practice variation and factors influencing sports restrictions in these children.

Methods:

This retrospective single-centre study included children (7–18 years old) with an isolated bicuspid aortic valve at baseline from 1 January, 2005 to 31 December, 2014. Sports restrictions, factors potentially influencing decision-making, and outcomes were collected. Descriptive statistics and multivariable mixed-effects logistic regression models were performed with providers and patients as random effects. Provider variation was estimated using intraclass correlation coefficients. Odds ratios, 95% confidence intervals, and p-values were reported from the models.

Results:

In 565 encounters (253 children; 34 providers), 41% recommended no sports restrictions, 40% recommended high-static and high-dynamic restrictions, and 19% had no documented recommendations. Based on published guidelines, 22% of children were inappropriately restricted while 30% were not appropriately restricted. The paediatric cardiology provider contributed to 37% of observed practice variation (p < 0.001). Sports restriction was associated with older age, males, greater ascending aorta z-score, and shorter follow-up interval. There were no aortic dissections or deaths and one cardiac intervention.

Conclusion:

Physicians frequently fail to document sports restrictions for children with a bicuspid aortic valve, and documented recommendations often conflict with published guidelines. Despite this, no adverse outcomes occurred. Providers accounted for a significant proportion of the variation in sports restrictions. Further research to provide evidence-based guidelines may improve provider compliance with activity recommendations in this population.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

De Mozzi, P, Longo, UG, Galanti, G, Maffulli, N. Bicuspid aortic valve: a literature review and its impact on sport activity. Br Med Bull 2008; 85: 6385.CrossRefGoogle ScholarPubMed
Galanti, G, Stefani, L, Toncelli, L, Vono, MC, Mercuri, R, Maffulli, N. Effects of sports activity in athletes with bicuspid aortic valve and mild aortic regurgitation. Br J Sports Med 2010; 44: 275279.CrossRefGoogle ScholarPubMed
Stefani, L, Galanti, G, Toncelli, L, et al. Bicuspid aortic valve in competitive athletes. Br J Sports Med 2008; 42: 3135.CrossRefGoogle ScholarPubMed
de Virgilio, C, Nelson, RJ, Milliken, J, et al. Ascending aortic dissection in weight lifters with cystic medial degeneration. Ann Thorac Surg 1990; 49: 638642.CrossRefGoogle ScholarPubMed
Elefteriades, JA, Hatzaras, I, Tranquilli, MA, et al. Weight lifting and rupture of silent aortic aneurysms. JAMA 2003; 290: 28032803.CrossRefGoogle ScholarPubMed
Ragucci, MV, Thistle, HG. Weight lifting and type II aortic dissection. A case report. J Sports Med Phys Fitness. 2004; 44: 424427.Google ScholarPubMed
Iskander, A, Thompson, PD. A meta-analysis of aortic root size in elite athletes. Circulation 2013; 127: 791798.CrossRefGoogle Scholar
Basso, C, Boschello, M, Perrone, C, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Card 2004; 93: 661663.CrossRefGoogle ScholarPubMed
Ward, C. Clinical significance of the bicuspid aortic valve. Heart 2000; 83: 8185.CrossRefGoogle ScholarPubMed
Bonow, RO, Cheitlin, MD, Crawford, MH, Douglas, PS. Task Force 3: valvular heart disease. J Am Coll Cardiol 2005; 45: 13341340.CrossRefGoogle ScholarPubMed
Braverman, AC, Harris, KM, Kovacs, RJ, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 7: aortic diseases, including Marfan syndrome: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 2015; 132: e303e309.CrossRefGoogle ScholarPubMed
Baleilevuka-Hart, M, Teng, BJ, Carson, KA, Ravekes, WJ, Holmes, KW. Sports participation and exercise restriction in children with isolated bicuspid aortic valve. Am J Cardiol 2020; 125: 16731677.CrossRefGoogle ScholarPubMed
Monda, E, Fusco, A, Della Corte, A, et al. Impact of regular physical activity on aortic diameter progression in paediatric patients with bicuspid aortic valve. Pediatr Cardiol 2021; 42: 11331140.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377381.CrossRefGoogle ScholarPubMed
Firth, D. Bias reduction of maximum likelihood estimates. Biometrika 1993; 80: 2738.CrossRefGoogle Scholar
Yamauchi, MSW, Puchalski, M, Weng, H, et al. Disease progression and variation in clinical practice for isolated bicuspid aortic valves in children. Congenit Heart Disease 2018; 13: 432439.CrossRefGoogle ScholarPubMed
Boraita, A, Morales-Acuna, F, Mainra-Breysse, M, et al. Bicuspid aortic valve behaviour in elite athletes. Eur Heart J Cardiovasc Imaging 2019; 20: 772780.CrossRefGoogle ScholarPubMed
Gati, S, Malhotra, A, Sharma, S. Exercise recommendations in patients with valvular heart disease. Heart 2019; 105: 106111.CrossRefGoogle ScholarPubMed
Guthold, R, Stevens, GA, Riley, LM, Bull, FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1.6 milliion participants. Lancet Child Adolesc Health 2020; 4: 2325.CrossRefGoogle Scholar
Hallal, PC, Andersen, LB, Bull, FC, Guthold, R, Haskell, W, Ekelund, U. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012; 380: 247257.CrossRefGoogle ScholarPubMed
Hilton, EN, Lundbert, TR. Transgender women in the female category of sport: perspectives on testosterone suppression and performance advantage. Sports Med 2021; 51: 199214.CrossRefGoogle ScholarPubMed
Bassett, AJ, Ahlmen, A, Rosendorf, JM, Romeo, AA, Erickson, BJ, Bishop, ME. The biology of sex and sport. JBJS Rev 2020; 8: e0140e0140.CrossRefGoogle ScholarPubMed
Longmuir, PE, Brothers, JA, de Ferranti, SD, et al. Promotion of physical activity for children and adults with congenital heart disease: a scientific statement from the American Heart Association. Circulation 2013; 127: 21472159.CrossRefGoogle ScholarPubMed
Dean, PN, Gillespie, CW, Greene, EA, et al. Sports participation and quality of life in adolescents and young adults with congenital heart disease. Congenit Heart Dis 2015; 10: 169179.CrossRefGoogle Scholar

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