Abstract
ObjectiveTo evaluate documentation of cardiovascular (CV) risk factors and obesity management by pediatric cardiologists.Study designReview of medical records of obese (≥95th body mass index percentile) 2–17 year-old children presenting to outpatient pediatric cardiology over 1 year. Subjects were categorized as: heart disease (HD) with increased risk for atherosclerosis; HD with average risk for atherosclerosis; or no HD. Data were evaluated on documentation of the assessment of seven CV risk factors [including recognition of elevated blood pressure (BP)] and management of obesity. Multivariable logistic regression (LR) examined physician documentation of obesity intervention by risk groups, including age and gender.ResultsData on 730 subjects were analyzed; 16 % had HD with increased risk for atherosclerosis, 41 % had HD with average risk for atherosclerosis, and 43 % had no HD. Documentation of risk factor assessment was highest for physical inactivity (53 %) and recognition of obesity (47 %). Other factors (child dyslipidemia, diet, dysglycemia, and cigarette exposure) were documented less frequently. Elevated BP was found in 144 patients (20 %); 53/144 (37 %) had documentation of elevated BP recognition. An obesity intervention was documented in 62 % of records and did not significantly differ between risk groups. In the multivariate LR, physician documentation of obesity intervention did not significantly differ between risk groups.ConclusionsComplete assessment of CV risk factors in obese patients is low. The number of risk factors assessed was similar among patients with HD with average risk of atherosclerosis and HD with increased risk of atherosclerosis. Increased care coordination between cardiologists and primary care providers may lead to uniform, comprehensive CV risk assessment.
Highlights
Cardiovascular disease remains the leading cause of death in adults and is associated with known risk factors including dyslipidemia, hypertension, cigarette smoking, diabetes, obesity, physical inactivity, unhealthy diet and family history of premature coronary artery disease (Roger et al 2011; Panel 2002; Daniels et al 2008; Ross 1986)
The primary aim of this study is to evaluate the electronic medical record documentation by pediatric cardiology providers of cardiovascular risk factors in obese patients’ ages 2 to 17 years with and without heart disease who presented to an outpatient pediatric cardiology center over a 1 year period
We retrospectively reviewed medical records of obese (BMI ≥95th percentile) children ages 2 to 17 years who presented for an evaluation by a cardiologist at any of our 5 outpatient pediatric cardiology center clinics over a 1 year period
Summary
Cardiovascular disease remains the leading cause of death in adults and is associated with known risk factors including dyslipidemia, hypertension, cigarette smoking, diabetes, obesity, physical inactivity, unhealthy diet and family history of premature coronary artery disease (Roger et al 2011; Panel 2002; Daniels et al 2008; Ross 1986). Obesity can add to the risk of premature atherosclerosis (Berenson et al 1998) and is often associated with additional cardiovascular disease (CVD) risk factors including poor nutrition/diet, physical inactivity, hyperlipidemia and hypertension (Barlow and The Expert Committee 2007). These CVD risk factors, especially obesity, track from childhood into adult life (Gidding et al 2004; The et al 2010). Interventions targeting obesity-associated risk factors may slow the development of atherosclerosis and there is increasing evidence that reduction of these risks delays progression to clinical disease (Expert Panel on Integrated Guidelines for Cardiovascular Health Risk Reduction In Children and Adolescents 2011)
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