Grattan Michael J, Power Alyssa, Fruitman Deborah S, Islam Sunjidatul, Mackie Andrew S
Stollery Children's Hospital, Edmonton, Alberta, Canada.
Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada.
Can J Cardiol. 2015 Dec;31(12):1497.e23-8. doi: 10.1016/j.cjca.2015.04.032. Epub 2015 May 23.
Compliance with the April 2007 American Heart Association (AHA) infective endocarditis (IE) guidelines is not well described. We sought to evaluate the impact of these guidelines on the clinical practices of pediatric and adult congenital cardiologists.
We conducted a 2-centre retrospective cohort study, including patients who had at least 1 outpatient cardiology visit after April 1, 2008 and had 1 of 11 prespecified high- or low-risk congenital cardiac lesions. High-risk lesions required prophylaxis per the AHA guidelines; low-risk patients no longer required prophylaxis. Cardiology clinic letters were reviewed to determine if antibiotic prophylaxis and oral hygiene were addressed and whether prophylaxis was recommended. Comparisons were made before April 2007 vs at least 1 year after guideline publication.
We included 238 high-risk and 201 low-risk patients. IE prophylaxis was recommended for all study patients before April 2007. After April 2008, IE prophylaxis recommendations were reduced by 44.9% for low-risk patients (P < 0.0001) and 9.3% for high-risk patients (P = 0.0156). IE prophylaxis recommendations were documented in the medical record of 92% of patients (95% confidence interval, 88%-95%) before April 2007 vs 81% (77%-84%) after April 2008. Oral hygiene was emphasized for only 44% and 28% of patients before and after guideline revision (P = 0.0005).
The 2007 AHA guidelines resulted in significantly fewer recommendations for IE prophylaxis in low-risk patients. However, cardiologists continue to recommend prophylaxis for some low-risk patients and advise some high-risk patients against prophylaxis. These findings suggest disagreement or uncertainty within the cardiology community regarding current IE guidelines.
2007年4月美国心脏协会（AHA）感染性心内膜炎（IE）指南的依从性尚无充分描述。我们试图评估这些指南对儿科和成人先天性心脏病专家临床实践的影响。
我们进行了一项双中心回顾性队列研究，纳入2008年4月1日后至少有1次门诊心脏病就诊且患有11种预先指定的高风险或低风险先天性心脏病变之一的患者。根据AHA指南，高风险病变需要预防性用药；低风险患者不再需要预防性用药。对心脏病诊所信件进行审查，以确定是否提及抗生素预防和口腔卫生，以及是否推荐预防性用药。比较2007年4月之前与指南发布后至少1年的情况。
我们纳入了238例高风险患者和201例低风险患者。2007年4月之前，所有研究患者均推荐进行IE预防。2008年4月之后，低风险患者的IE预防推荐减少了44.9%（P<0.0001），高风险患者减少了9.3%（P=0.0156）。2007年4月之前，92%的患者（95%置信区间，88%-95%）的病历中有IE预防推荐记录，而2008年4月之后为81%（77%-84%）。指南修订前后，分别只有44%和28%的患者强调了口腔卫生（P=0.0005）。
2007年AHA指南导致低风险患者的IE预防推荐显著减少。然而，心脏病专家继续对一些低风险患者推荐预防性用药，并建议一些高风险患者不要进行预防性用药。这些发现表明心脏病学界对当前IE指南存在分歧或不确定性。
