The Impact of a Designated Cardiology Team Involving Telemedicine Home Monitoring on the Care of Children with Single-Ventricle Physiology After Norwood Palliation

• Published in: Pediatric cardiology Vol. 37; no. 5; pp. 899 - 912
• Main Authors: Harahsheh, Ashraf S., Hom, Lisa A., Clauss, Sarah B., Cross, Russell R., Curtis, Amy R., Steury, Rachel D., Mitchell, Stephanie J., Martin, Gerard R.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2016
• Subjects: Cardiac Surgery; Cardiology; Child; Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Infant; Medicine; Medicine & Public Health; Norwood Procedures; Original Article; Palliative Care; Retrospective Studies; Risk Factors; Telemedicine; Treatment Outcome; Vascular Surgery; Quality improvement; Hypoplastic left heart syndrome; Interstage; Stage I palliation; Family-centered care
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-016-1366-y

We evaluated the effect of an interdisciplinary single-ventricle task force (SVTF) that utilizes a family-driven, telemedicine home monitoring program on clinical outcomes of stage II admissions and its acceptance by parents and cardiologists. Study population was divided into two cohorts, one with Norwood surgery dates before the SVTF (pre-SVTF) and one interventional (post-SVTF). Post-SVTF data also included surveys of parents and cardiologists on the efficacy of the SVTF. Comparative and multivariate statistical testing was performed. Compared to the pre-SVTF group, the post-SVTF group had lower complications after stage II (18.4 vs. 34.1 %, p  = 0.02), higher weight-for-age z scores at stage II (−1.5 ± 0.97 vs. −1.58 ± 1.34, p  = 0.02) and were less likely to have a stage II weight-for-age z score below −2 (26.5 vs. 31.7 %, p = 0.03). A multivariate regression analysis showed providing a written red-flag action plan to parents at discharge was independently associated with higher weight at stage II ( β  = 0.42, p  = 0.04) and higher weight-for-age z score ( β  = 0.48, p  = 0.02). Parents’ satisfaction with SVTF ( α  = 0.97) was 4.34 ± 0.62; (95 % CI 4.01–4.67) and cardiologists’ acceptance ( α  = 0.93) was 4.1 ± 0.7 (95 % CI 3.79–4.42). Development of SVTF was associated with a reduction in complications post-stage II and improved weight status at stage II. A written red-flag action plan provided to parents at the time of Norwood discharge was associated with higher weight status at stage II. Parents and cardiologists expressed satisfaction with the utility of SVTF and encouraged expansion to cover all children with congenital heart disease.