AAP publishes list of heart-related practices that may be unnecessary
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In coordination with the Choosing Wisely initiative, the AAP released a list of common medical therapies and practices related to pediatric heart health that may be unnecessary, such as routine ECGs for student athletes.
The AAP Section on Cardiology and Cardiac Surgery developed the evidence-based list based on common issues that come up during pediatric visits, like sports exams and ECGs, said the chair of the section, Christopher S. Snyder, MD, FAAP.
“Even during COVID-19, every child who is going to participate in any kind of sports, 6th grade and up, should have a physical exam by a pediatrician or primary care physician,” Snyder said in an AAP news release. “We have never seen a study that shows that every child needs an ECG before playing sports. The Choosing Wisely initiative can help inform discussions for physicians and families during these visits.”
Choosing Wisely is a national campaign aimed at helping patients and providers choose only care that is necessary, free from harm, supported by evidence and not duplicative of tests or procedures already received.
According to the AAP, unnecessary treatments often generate false-positive findings that can lead to more testing, expense, inconvenience and painful, invasive diagnostic or therapeutic procedures.
Often, adult cardiologists or adult doctors misinterpret pediatric ECG results, which include differences that are normal for children but not adults, Snyder said.
“It depends on who is reading the ECG vs. who is not,” he told Healio. “In general, I would say [false-positive results occur in] somewhere around 3% to 10% of the ECGs that we interpret.”
The list of potentially unnecessary treatments or testing:
- Do not routinely order a screening ECG as part of a sports participation examination in asymptomatic, healthy patients with no personal or family history of cardiac disease.
- Do not order a screening ECG prior to the initiation of ADHD therapy in asymptomatic, healthy patients with no personal or family history of cardiac disease.
- Do not order an echocardiogram for the routine evaluation of pediatric syncope in the absence of a concerning history or ECG abnormalities.
- Do not order an echocardiogram for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities.
- Do not order troponins for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities.
The AAP said that when taking a family history, physicians should assess specifically for the following types of cardiovascular diseases: connective tissue disorders, cardiomyopathies, arrythmias, storage diseases, sudden unexplained death and premature cardiovascular disease before the age of 50 years.
In September, AAP issued guidelines for student athletes returning to sports-related activities in the midst of the COVID-19 pandemic that also included advice about ECGs. Based on growing evidence that SARS-CoV-2 infection severely damages the heart, the AAP said that children who had COVID-19 may need an ECG before returning to play.
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Choosing Wisely. American Academy of Pediatrics – Section on cardiology and cardiac surgery: Five things physicians and patients should question related to pediatric cardiology. Accessed Nov. 2, 2020.
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