Lentzner Benjamin J, Connolly Dana M, Phoon Colin K L
Pediatric Cardiology Program, New York University School of Medicine, New York 10016, USA.
Cardiol Young. 2003 Dec;13(6):551-8.
Atherosclerotic disease of the heart likely has its origins in childhood. The promotion of cardiovascular health in children, however, has been studied only for those practicing in general paediatrics. We hypothesised that paediatric cardiologists do not consistently discuss cardiovascular risk factors with patients and their families. We therefore, carried out a nationwide survey of paediatric cardiologists to determine how often they discussed atherosclerosis and 4 modifiable risk factors, specifically weight, smoking, diet and nutrition, and physical activity. Only two-fifths reported that they discussed atherosclerotic disease frequently to always. For patients with cardiovascular disease, weight was discussed frequently to always by 59%, smoking by 61%, diet and nutrition by 63%, and physical activity by 92%. In contrast, for patients without cardiovascular disease, weight was discussed frequently to always by 35%, smoking by 46%, diet and nutrition by 39%, and physical activity by 62%. These differences are statistically significant (p < 0.003 by chi2 analysis). Cardiovascular risk factors were discussed more consistently as children grew older (p < 0.0001). Respondents stated that, in their opinion, the promotion of cardiovascular health was a role more appropriate for providers of primary care than for paediatric cardiologists (p < 0.0001). Constraints of time, and the perceived role of the cardiologist, were the most common barriers to anticipatory guidance. We suggest that these findings indicate that paediatric cardiologists can assume a more prominent role in preventive cardiology and education, although their precise role or roles, and the optimal methods of anticipatory guidance, remain controversial.
心脏的动脉粥样硬化疾病可能始于儿童时期。然而，仅针对普通儿科医生对促进儿童心血管健康进行了研究。我们推测儿科心脏病专家并未始终如一地与患者及其家属讨论心血管危险因素。因此，我们对全国范围内的儿科心脏病专家进行了一项调查，以确定他们讨论动脉粥样硬化和4种可改变的危险因素（具体为体重、吸烟、饮食与营养以及体育活动）的频率。只有五分之二的人报告称他们经常至总是会讨论动脉粥样硬化疾病。对于患有心血管疾病的患者，经常至总是会讨论体重的比例为59%，吸烟为61%，饮食与营养为63%，体育活动为92%。相比之下，对于没有心血管疾病的患者，经常至总是会讨论体重的比例为35%，吸烟为46%，饮食与营养为39%，体育活动为62%。这些差异具有统计学意义（经卡方分析，p<0.003）。随着儿童年龄增长，心血管危险因素的讨论更加一致（p<0.0001）。受访者表示，他们认为促进心血管健康对于初级保健提供者而言比儿科心脏病专家更合适（p<0.0001）。时间限制以及对心脏病专家角色的认知是进行预期指导最常见的障碍。我们认为这些发现表明，儿科心脏病专家可以在预防心脏病学和教育中发挥更突出的作用，尽管他们的确切角色以及预期指导的最佳方法仍存在争议。
