Abstract
To compare the current practice of US Pediatric Cardiologists with the 1994 guidelines of the American Heart Association (94-AHA) in the management of Kawasaki disease (KD), a multiple-choice survey was sent to those practicing in US fellowship programs. Opinions of 97/350 (28%) physicians practicing in 29/40 (73%) programs are summarized: Years of practice in pediatric cardiology (average±SD) was 13.2±10 for respondents vs. 13.6±10.5 for non-respondents (p=0.69). In contrast to 94-AHA guidelines, 10% of respondents use low- or moderate-dose Aspirin in the acute phase of KD and another 12% are aware of colleagues who do so. Another 50% who use high-dose, recommend clinical trials to evaluate Aspirin dose recommendation. Clinical criteria (validated in Japan) for patient selection to administer IVIG are followed by 3% of the respondents, and another 18% feel that similar criteria need to be evaluated for use in the US. In contrast to 94-AHA recommendations, 70% advise follow-up for risk-level I patients. For risk-level II, only 20% follow the 94-AHA no-follow-up option while 80% provide regular follow-up, 34% utilizing advanced diagnostic testing. For risk-level IV patients, 84% prefer periodic stress-echo (45%) or stress-perfusion scan (40%) vs 15% who prefer periodic echo at rest or stress ECG (94-AHA does not provide clear recommendation). For asymptomatic patients, 24% do not council for healthy lifestyle habits unless patients have persistent coronary aneurysms or other known coronary risk factors. For persistent coronary aneurysms 36% perform cardiac catheterization periodically, the others catheterize in presence of coronary symptoms (9%), abnormal stress echo (20%), or abnormal stress myocardial perfusion (18%). Conclusion: The respondents' opinion was in concert with data from the most recent literature, but in contrast with many 94-AHA recommendations. The current trend in KD cardiovascular management in US teaching institutions suggests a need for an update in the current official guidelines.
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