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. 2023 Oct;33(10):1813-1818.
doi: 10.1017/S1047951122003110. Epub 2022 Oct 6.

Variation in provider compliance with sports restriction guidelines in children with an isolated bicuspid aortic valve

Melissa S W Yamauchi  1 , Michael D Puchalski  2 , Hsin-Yi Weng  3 , Nelangi M Pinto  4   5 , Susan P Etheridge  4   5 , Angela P Presson  4 , L LuAnn Minich  4   5 , Richard V Williams  4   5
Affiliations

Variation in provider compliance with sports restriction guidelines in children with an isolated bicuspid aortic valve

Melissa S W Yamauchi et al. Cardiol Young. 2023 Oct.

Abstract

Background: Published guidelines for sports restriction for children with a bicuspid aortic valve remain controversial. We sought to describe practice variation and factors influencing sports restrictions in these children.

Methods: This retrospective single-centre study included children (7-18 years old) with an isolated bicuspid aortic valve at baseline from 1 January, 2005 to 31 December, 2014. Sports restrictions, factors potentially influencing decision-making, and outcomes were collected. Descriptive statistics and multivariable mixed-effects logistic regression models were performed with providers and patients as random effects. Provider variation was estimated using intraclass correlation coefficients. Odds ratios, 95% confidence intervals, and p-values were reported from the models.

Results: In 565 encounters (253 children; 34 providers), 41% recommended no sports restrictions, 40% recommended high-static and high-dynamic restrictions, and 19% had no documented recommendations. Based on published guidelines, 22% of children were inappropriately restricted while 30% were not appropriately restricted. The paediatric cardiology provider contributed to 37% of observed practice variation (p < 0.001). Sports restriction was associated with older age, males, greater ascending aorta z-score, and shorter follow-up interval. There were no aortic dissections or deaths and one cardiac intervention.

Conclusion: Physicians frequently fail to document sports restrictions for children with a bicuspid aortic valve, and documented recommendations often conflict with published guidelines. Despite this, no adverse outcomes occurred. Providers accounted for a significant proportion of the variation in sports restrictions. Further research to provide evidence-based guidelines may improve provider compliance with activity recommendations in this population.

Keywords: Bicuspid aortic valve; children; exercise; sports.

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