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Screening of adults with congenital cardiac disease lost for follow-up

Published online by Cambridge University Press:  24 October 2007

Kasper Iversen ,
Niels G. Vejlstrup ,
Lars Sondergaard  and
Olav W. Nielsen
Kasper Iversen*
Affiliation:
The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Niels G. Vejlstrup
Affiliation:
The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Lars Sondergaard
Affiliation:
The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Olav W. Nielsen
Affiliation:
The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
*
Correspondence to: Dr Kasper Iversen MD, Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen Ø, Denmark. Tel: +45 3545 2018; Fax: +45 3545 2648; E-mail: [email protected]
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Abstract

Objective

A problem facing doctors treating adults with congenitally malformed hearts is that a significant number of these patients are lost for follow-up. The purpose of our study is to describe the medical history and clinical findings in a group of such adults that was lost for follow-up.

Design, settings and patients

The Danish press ran a front-page story about adults with congenitally malformed hearts who were lost for follow-up. These patients were strongly advised to contact a center for congenital cardiac disease, and we examined all responding patients within four-weeks.

Interventions

We carried out a structured interview, a clinical examination, echocardiography, and measured levels of N-terminal pro brain natriuretic peptide.

Results

The number of responders was 147. Based on the diagnosis and the findings, further follow-up was scheduled for 52 (35.4%), either because of significant residual lesions, found in 32, or the risk of late complications, judged to be present in 20. Symptoms were present in 36.5% of patients scheduled for follow-up. The presence of a heart murmur was highly predictive of the need for further follow-up but the sensitivity was too low to recommend the use of auscultation as a screening test.

Conclusion

A large proportion of adults with congenitally malformed hearts who are lost for follow-up require regular assessment according to a modern standard. Symptoms, signs, and measurement of natriuretic peptide cannot replace full cardiological assessment. It is a challenge for centres treating adults with congenital heart disease to find the lost group of patient with significant cardiac malformations.

Keywords

Grown-up congenital heart diseaseechocardiographyauscultationnatriuretic peptides
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 6 , December 2007 , pp. 601 - 608
Copyright
Copyright © Cambridge University Press 2007

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