Abstract
Objectives The purpose of our survey is to analyze the clinical approach used by interventional and imaging cardiologists to diagnose, treat, and follow-up patients with PFO-related left circulation thromboembolism in different parts of the world with particular emphasis on adherence to current guidelines. Background Firm guidelines do not cover many aspects of PFO-related patient care. Consequently, very disparate approaches exist among clinicians in the real-world. Methods A 24-item electronic questionnaire was sent directly to experienced cardiology specialists practicing at consultant/attending positions directly involved in PFO closure management in the United States, United Kingdom, Gulf countries, and other countries. There were no unanswered questions. Responses were recorded between October 2019 and July 2020. Results Seventy-one responses were obtained: 31 from the UK, 19 from the US, 16 from Gulf countries, 2 from Poland, and 1 response from Australia, Italy, and Switzerland. The overall response rate was 76%. Significant differences between regions were noted in the duration of ECG monitoring during the diagnostic process, PFO closure for left circulation thromboembolism other than stroke/transient ischemic attack, and intraoperative use of intracardiac echocardiography. A similar pattern was noted in the lack of routine screening for thrombophilia and the use of the long-term single antiplatelet therapy. Conclusions The study shows a vast spectrum of opinions on the optimal approach to PFO closure with significant differences between the US, UK, and Gulf countries. The results stress the need for systematic, high-quality data on the diagnostic work-up and follow-up strategies to inform the standardized approach.
Highlights
Maciej Debski,1,2 Amr Abdelrahman,1 Halia Alshehri,3 Marloe Prince,4 Andrew Wiper,1 Shajil Chalil,1 Dariusz Dudek,5,6 Christopher J
Silent atrial fibrillation (AF) as the cause for thromboembolism was excluded with the use of 7–30-day continuous ECG monitoring (n 39, 55%), escalated to insertable cardiac monitor (ICM) if appropriate (n 17, 24%). e rest of the respondents (n 32, 45%) felt that short-term ECG Holter monitoring ranging from 1 to 5 days was sufficient. 6% of respondents required a routine full screen for hypercoagulable disorders before PFO closure, 27% required screening only in patients with relevant family history, and
76% of cardiologists performed PFO closure in one or more of the following indications: decompression sickness, migraine with aura, and platypnea-orthodeoxia syndrome. It is the first survey capturing opinions of consultant cardiologists directly involved in PFO closure in different parts of the world. e previous survey on PFO closure practice included 120 physicians in the UK, the vast majority of whom were noncardiologists [7]. is survey provides an insight into current clinical practice related to selection and management in patients with left circulation thromboembolism and shows how varied cardiologists’ practice is regarding PFO closure. e evidence base for PFO closure for secondary prevention in patients with left circulation thromboembolism has been elusive, and it is only recent that an official position study has been published [6]
Summary
Maciej Debski ,1,2 Amr Abdelrahman ,1 Halia Alshehri, Marloe Prince ,4 Andrew Wiper ,1 Shajil Chalil, Dariusz Dudek ,5,6 Christopher J. E purpose of our survey is to analyze the clinical approach used by interventional and imaging cardiologists to diagnose, treat, and follow-up patients with PFO-related left circulation thromboembolism in different parts of the world with particular emphasis on adherence to current guidelines. E study shows a vast spectrum of opinions on the optimal approach to PFO closure with significant differences between the US, UK, and Gulf countries. 1. Introduction e recent publications of long-term outcomes from randomized controlled trials and meta-analyses confirm the efficacy of PFO closure in mitigating the risk of recurrent ischemic stroke compared with the antiplatelet therapy alone in patients with cryptogenic stroke [1,2,3,4,5]. Issued a position study on the management of patients with PFO and systemic thromboembolism in order to guide a rational approach to PFO management from the index event to follow-up [6]. e experts acknowledged very disparate approaches among clinicians in the real-world and stressed the need for urgent evaluation. erefore, we aimed to capture the contemporary routine clinical practice of cardiologists specializing in PFO management and their adherence to key recommendations on an international level
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