Three year experience of a clinical cardiovascular genetics program for infants with congenital heart disease

Abstract

Objective: To describe the first 3 years of experience of having an inpatient "cardiogenetics" program which involves medical geneticist assessment of infants with major congenital heart disease (CHD) requiring surgical intervention in the first year of life.

Patients: Patients less than a year of age admitted to Children's Hospital of Wisconsin's Herma Heart Institute for surgical intervention for CHD seen by the cardiogenetics program. Patients with major trisomies (13, 18, and 21) were excluded.

Outcome measures: Utilization and yield of genetic testing, and diagnostic rate were assessed as outcome measures and compared to a baseline time period and a genetic testing protocol time period.

Results: There were 201 infants with CHD evaluated by the cardiogenetics program over 3 years. A total of patients 46 patients of the 196 who underwent genetic testing had multiple tests completed. This is a significant decrease from the baseline (247/329, P < .0001) and from the genetic testing protocol (29/81, P < .0387) time periods. The diagnostic rate was 33% which is significantly increased compared to the baseline rate of 15% (80/524, P < .0001) and trends toward a significant increase during the testing protocol rate (25/113, P = .0520). The number of dual diagnosis increased to 9 of 201 compared to the baseline (2/524) and the genetic testing protocol (1/113) time periods. The rate of incidental diagnoses altering care increased to 6 of 201 from the baseline (1/524) and the genetic testing protocol (1/113) time periods.

Conclusion: An inpatient cardiogenetics program significantly increases the diagnostic rate, the detection of complex phenotypes with dual diagnoses, the identification of incidental genetic diagnoses associated with changes in care, and significantly decreases the likelihood of multiple tests being completed on an individual patient. Increased medical geneticist involvement in programs that care for infants with CHD should be encouraged to improve patient care and genetic testing utilization.

Keywords: cardiovascular genetics; congenital heart disease; genetic testing.

Figure 1

Volume of consults by quarter. Number of consults by quarter with a minimum of 9 and a maximum of 23 with a mean of 17. Number of surgeries completed on infants less than a year of age for congenital heart disease included for reference. The number of surgeries is an overestimate of the number of possible cardiovascular genetics consults due to inability to pull specifics on each patients to exclude those who would have been ineligible for consultation and multiple procedures performed on the same patient. On average 68% of the surgical volume underwent a cardiovascular genetic consultation; however, due to our volume data limitations the number of target patients who underwent consultation is actually higher