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Woo JL, Burton S, Iyengar T, Sivakumar A, Spiewak S, Wakulski R, Grobman WA, Davis MM, Yee LM, Patel A, Johnson JT, Patel S, Gandhi R. Patient-reported barriers to prenatal diagnosis of congenital heart defects: A mixed-methods study. Prenat Diagn 2024; 44:57-67. [PMID: 38108462 DOI: 10.1002/pd.6481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To ascertain patient-reported, modifiable barriers to prenatal diagnosis of congenital heart defects (CHDs). METHODS This was a mixed-methods study among caretakers of infants who received congenital heart surgery from 2019 to 2020 in the Chicagoland area. Quantitative variables measuring sociodemographic characteristics and prenatal care utilization, and qualitative data pertaining to patient-reported barriers to prenatal diagnosis were collected from electronic health records and semi-structured phone surveys. Thematic analysis was performed using a convergent parallel approach. RESULTS In total, 160 caretakers completed the survey, 438 were eligible for survey, and 49 (31%) received prenatal care during the COVID-19 pandemic. When comparing respondents and non-respondents, there was a lower prevalence of maternal Hispanic ethnicity and a higher prevalence of non-English/Spanish-speaking households. Of all respondents, 34% reported an undetected CHD on ultrasound or echocardiogram, while 79% reported at least one barrier to prenatal diagnosis related to social determinants of health. Among those social barriers, the most common were difficulty with appointment scheduling (n = 12, 9.5%), far distance to care/lack of access to transportation (n = 12, 9.5%) and difficulty getting time off work to attend appointments (n = 6, 4.8%). The latter two barriers were correlated. CONCLUSION While technical improvements in the detection of CHDs remain an important area of research, it is equally critical to produce evidence for interventions that mitigate barriers to prenatal diagnosis due to social determinants of health.
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Affiliation(s)
- Joyce L Woo
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shelvonne Burton
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Health Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Tara Iyengar
- Division of Cardiology, Department of Pediatrics, Advocate Christ Children's Hospital, Chicago, Illinois, USA
| | - Adithya Sivakumar
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Rush Medical College, Chicago, Illinois, USA
| | - Sarah Spiewak
- Division of Cardiology, Department of Pediatrics, Advocate Christ Children's Hospital, Chicago, Illinois, USA
| | - Renee Wakulski
- Division of Cardiology, Department of Pediatrics, Advocate Christ Children's Hospital, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Matthew M Davis
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Health Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Advanced General Pediatrics & Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M Yee
- Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Angira Patel
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joyce T Johnson
- Division of Cardiology, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Sheetal Patel
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rupali Gandhi
- Division of Cardiology, Department of Pediatrics, Advocate Christ Children's Hospital, Chicago, Illinois, USA
- Section of Cardiology, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois, USA
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2
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Regouin M, Mancini J, Lafouge A, Mace P, Fontaine N, Roussin S, Guichard J, Dumont C, Quarello E. The Left Outflow Tract in Fetal Cardiac Screening Examination: Introduction of Quality Criteria Is Not Always Associated With an Improvement of Practice When Supervised by Humans. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2095-2105. [PMID: 37163223 DOI: 10.1002/jum.16231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/11/2023] [Accepted: 04/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Since 2016, the French CNEOF included the left ventricular outflow tract (LVOT) in the second and third trimester of pregnancy in addition to the four-chamber view and the parasagittal view of the right outflow tract. The objective of this study was to define quality criteria for fetal LVOT assessment and to perform a human audit of past and current practices, before and after the implementation of those quality criteria at a large scale. METHODS Seven quality criteria were investigated and rated from 0 to 1 during three periods of interest. Files were randomly selected from three centers, and average total and specific scores were calculated. RESULTS LVOT pictures were present in more than 94.3% of reports. The average quality score was 5.49/7 (95% confidence interval [CI]: 5.36-5.62), 5.91/7 (95% CI: 5.80-6.03), and 5.70/7 (95% CI: 5.58-5.82) for the three centers in the three periods of interest. There was no significant difference following the introduction of the quality criteria, 2017 versus 2020, P = .054. CONCLUSION Fetal LVOT images were present in most of ultrasound reports but the introduction of the proposed quality criteria under human supervision seems not associated with a significant change in practice.
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Affiliation(s)
- Maud Regouin
- Département de Gynécologie Obstétrique, Hôpital Sud de la Réunion, Réunion, France
| | - Julien Mancini
- APHM, INSERM, IRD, SESSTIM, Hop Timone, Public Health Department (BIOSTIC), Aix Marseille University, Marseille, France
| | | | - Pierre Mace
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, la Grossesse et l'Enfance IMAGE2, Marseille, France
- Hôpital Beauregard, Marseille, France
| | - Nathalie Fontaine
- Département de Gynécologie Obstétrique, Hôpital Sud de la Réunion, Réunion, France
| | | | - Jimmy Guichard
- Cabinet d'Echographie Gynécologique et Obstétricale-Espace 9 Mois, Montreuil, France
| | - Coralie Dumont
- Département de Gynécologie Obstétrique, Hôpital Sud de la Réunion, Réunion, France
| | - Edwin Quarello
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, la Grossesse et l'Enfance IMAGE2, Marseille, France
- Unité de Dépistage et de Diagnostic Prénatal, Hôpital Saint-Joseph, Marseille, France
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3
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Nagata H, Yamamura K, Matsuoka R, Kato K, Ohga S. Transition in cardiology 2: Maternal and fetal congenital heart disease. Pediatr Int 2022; 64:e15098. [PMID: 35507001 DOI: 10.1111/ped.15098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
The number of women with congenital heart disease (CHD) reaching reproductive age has been increasing. Many women with CHDs are desirous of pregnancy, but they face issues regarding preconception, antepartum, and postpartum management. On the other hand, the fetal diagnosis of CHD has improved with advances in the technique and equipment for fetal echocardiography. Recently, experiences with fetal intervention have been reported in patients with severe CHD, such as critical aortic stenosis. Nevertheless, some types of CHD are challenge to diagnose prenatally, resulting in adverse outcomes. Medical care is part of the transitional care for women and fetuses with CHD during the perinatal period. Pre-conceptional and prenatal counseling play an important role in transitional care. Sex and reproductive education need to be performed as early as possible. We herein review the current status, important issues to be resolved, and the future of maternal and fetal CHD to relevant caregivers.
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Affiliation(s)
- Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryohei Matsuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abstract
Most children with congenital heart disease (CHD) survive to adulthood, owing largely to significant advances in the diagnosis and management of CHD over the past few decades. Primary care providers are essential partners in the recognition and management of these patients in our current medical environment. This article reviews the role of the primary care physician in detecting fetuses, infants, and children with possible CHD. Furthermore, this article discusses common primary care issues arising for patients with CHD, including growth and development, mental illness, dental care, and the transition to adult primary care.
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Affiliation(s)
- Michael Scott
- Department of Pediatrics, University of Louisville, Office of Medical Education, School of Medicine, 571 South Floyd, Suite 412, Louisville, KY 40202, USA
| | - Ashley E Neal
- Department of Pediatrics, University of Louisville School of Medicine and Norton Children's, 571 South Floyd Street, Suite 113, Louisville, KY 40202, USA.
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5
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Krishnan A, Jacobs MB, Morris SA, Peyvandi S, Bhat AH, Chelliah A, Chiu JS, Cuneo BF, Freire G, Hornberger LK, Howley L, Husain N, Ikemba C, Kavanaugh-McHugh A, Kutty S, Lee C, Lopez KN, McBrien A, Michelfelder EC, Pinto NM, Schwartz R, Stern KWD, Taylor C, Thakur V, Tworetzky W, Wittlieb-Weber C, Woldu K, Donofrio MT. Impact of Socioeconomic Status, Race and Ethnicity, and Geography on Prenatal Detection of Hypoplastic Left Heart Syndrome and Transposition of the Great Arteries. Circulation 2021; 143:2049-2060. [PMID: 33993718 DOI: 10.1161/circulationaha.120.053062] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prenatal detection (PND) has benefits for infants with hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA), but associations between sociodemographic and geographic factors with PND have not been sufficiently explored. This study evaluated whether socioeconomic quartile (SEQ), public insurance, race and ethnicity, rural residence, and distance of residence (distance and driving time from a cardiac surgical center) are associated with the PND or timing of PND, with a secondary aim to analyze differences between the United States and Canada. METHODS In this retrospective cohort study, fetuses and infants <2 months of age with HLHS or TGA admitted between 2012 and 2016 to participating Fetal Heart Society Research Collaborative institutions in the United States and Canada were included. SEQ, rural residence, and distance of residence were derived using maternal census tract from the maternal address at first visit. Subjects were assigned a SEQ z score using the neighborhood summary score or Canadian Chan index and separated into quartiles. Insurance type and self-reported race and ethnicity were obtained from medical charts. We evaluated associations among SEQ, insurance type, race and ethnicity, rural residence, and distance of residence with PND of HLHS and TGA (aggregate and individually) using bivariate analysis with adjusted associations for confounding variables and cluster analysis for centers. RESULTS Data on 1862 subjects (HLHS: n=1171, 92% PND; TGA: n=691, 58% PND) were submitted by 21 centers (19 in the United States). In the United States, lower SEQ was associated with lower PND in HLHS and TGA, with the strongest association in the lower SEQ of pregnancies with fetal TGA (quartile 1, 0.78 [95% CI, 0.64-0.85], quartile 2, 0.77 [95% CI, 0.64-0.93], quartile 3, 0.83 [95% CI, 0.69-1.00], quartile 4, reference). Hispanic ethnicity (relative risk, 0.85 [95% CI, 0.72-0.99]) and rural residence (relative risk, 0.78 [95% CI, 0.64-0.95]) were also associated with lower PND in TGA. Lower SEQ was associated with later PND overall; in the United States, rural residence and public insurance were also associated with later PND. CONCLUSIONS We demonstrate that lower SEQ, Hispanic ethnicity, and rural residence are associated with decreased PND for TGA, with lower SEQ also being associated with decreased PND for HLHS. Future work to increase PND should be considered in these specific populations.
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Affiliation(s)
- Anita Krishnan
- Divisions of Cardiology (A.K., M.T.D.), Children's National Hospital, Washington, DC
| | - Marni B Jacobs
- Biostatistics (M.B.J.), Children's National Hospital, Washington, DC.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego (M.B.J.)
| | - Shaine A Morris
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX (S.A.M., K.N.L.)
| | - Shabnam Peyvandi
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco (S.P.)
| | - Aarti H Bhat
- Division of Cardiology, Seattle Children's Hospital, University of Washington (A.H.B.)
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York (A.C.)
| | - Joanne S Chiu
- Division of Pediatric Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.).,Division of Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston (J.S.C.)
| | - Bettina F Cuneo
- Division of Cardiology, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.)
| | - Grace Freire
- Division of Cardiology, Johns Hopkins University All Children's Hospital, St. Petersburg, FL (G.F.)
| | - Lisa K Hornberger
- Division of Pediatric Cardiology, University of Alberta, Edmonton, Canada (L.K.H., A.M.)
| | - Lisa Howley
- Division of Cardiology, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.).,Division of Cardiology, The Children's Heart Clinic/Children's Minnesota, Minneapolis (L.H.)
| | - Nazia Husain
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL (N.H.)
| | - Catherine Ikemba
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (C.I., K.W.)
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN (A.K.-M.)
| | - Shelby Kutty
- Division of Pediatric Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.).,University of Nebraska Medical Center, Omaha (S.K.)
| | - Caroline Lee
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.L.)
| | - Keila N Lopez
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX (S.A.M., K.N.L.)
| | - Angela McBrien
- Division of Pediatric Cardiology, University of Alberta, Edmonton, Canada (L.K.H., A.M.)
| | - Erik C Michelfelder
- Emory University School of Medicine, Children's Healthcare of Atlanta/Sibley Heart Center, GA (E.C.M.)
| | - Nelangi M Pinto
- Division of Pediatric Cardiology, University of Utah, Salt Lake City (N.M.P.)
| | - Rachel Schwartz
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.).,The George Washington School of Medicine, Washington, DC (R.S.)
| | - Kenan W D Stern
- Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York (K.W.D.S.)
| | - Carolyn Taylor
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston (C.T.)
| | - Varsha Thakur
- Division of Cardiology, University of Toronto, Ontario, Canada (V.T.)
| | - Wayne Tworetzky
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.)
| | - Carol Wittlieb-Weber
- Division of Pediatric Cardiology, University of Rochester, NY (C.W.-W.).,Division of Cardiology, Children's Hospital of Philadelphia, PA (C.W.-W.)
| | - Kris Woldu
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (C.I., K.W.).,Division of Cardiology, Cook Children's Heart Center, Ft. Worth, TX (K.W.)
| | - Mary T Donofrio
- Divisions of Cardiology (A.K., M.T.D.), Children's National Hospital, Washington, DC
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6
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Weichert J, Weichert A. A "holistic" sonographic view on congenital heart disease: How automatic reconstruction using fetal intelligent navigation echocardiography eases unveiling of abnormal cardiac anatomy part II-Left heart anomalies. Echocardiography 2021; 38:777-789. [PMID: 33778977 DOI: 10.1111/echo.15037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 12/19/2022] Open
Abstract
Volume ultrasound has been shown to provide valid complementary information on fetal anatomy. Four-dimensional assessment (4D) of the fetal cardiovascular system using spatial-temporal image correlation (STIC) allows for detailed examination of a highly complex organ from the early second trimester onward. There is compelling evidence that this technique harbors quite a number of diagnostic opportunities, but manual navigation through STIC volume datasets is highly operator dependent. In fact, STIC is not incorporated yet into daily practice. Application of the novel fetal intelligent navigation echocardiography (FINE) considerably simplifies fetal cardiac volumetric examinations. This automatic technique applied on cardiac volume datasets reportedly has both high sensitivity and specificity for the detection of congenital heart defects (CHDs). Part I reviewed current data regarding detection rates of CHDs and illustrated the additional value of an automatic approach in delineating cardiac anatomy exemplified by congenital lesions of the right heart. In part II of this pictorial essay, we focused on left heart anomalies and aimed to tabulate recent findings on the quantification of normal and abnormal cardiac anatomy.
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Affiliation(s)
- Jan Weichert
- Division of Prenatal Medicine, Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Luebeck, Germany.,Elbe Center of Prenatal Medicine and Human Genetics, Hamburg, Germany
| | - Alexander Weichert
- Department of Obstetrics, Charité-Universitätsmedizin Berlin - CCM, Berlin, Germany.,Prenatal Medicine Bergmannstrasse, Berlin, Germany
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