(P076) PEDIATRIC CARDIOLOGY REFERRAL TRENDS IN THE MARITIMES: PRELIMINARY ANALYSIS

Background: The IWK is the only pediatric cardiology referral centre in the Maritimes, uniquely positioning it to receive all outpatient pediatric cardiology referrals within Nova Scotia (NS), Prince Edward Island (PEI), and New Brunswick (NB). Our study looks to describe the numbers, reasons for and predictors of outcomes of outpatient pediatric cardiology referrals in the Maritimes and how they have changed over time. Understanding these parameters offers opportunities to change the current care model to improve access to specialist consultation.

METHODS AND RESULTS: We conducted a retrospective chart review of patients referred to pediatric cardiologists in NS, PEI, and NB between May 1, 2022 and April 30, 2023. Information regarding patients’ demographics, referrals, and outcomes was collected. Analysis focused on describing the referred population, and identifying predictors for referral, specific investigations, and organic disease. Data was compared to a similar 2012 study to assess trends. Chi squared testing was used to analyze frequency data while logistic regression was used to assess predictors of consultation outcome.

To date, data on 782 patients has been extracted and included in the preliminary analysis, representing a 126% increase in referrals compared to 2012 (p < 0.0001; 95%CI 118%, 146%). Referral reasons have significantly changed in the present era (p=0.005), and more organic disease is diagnosed (48.2% vs 27%, p< 0.0001). The main reasons for referral were the assessment of a murmur (27.1%) and having had a previously abnormal diagnostic test (19.4%). Of patients referred for a murmur, 53% received echocardiograms and 31% were diagnosed with organic disease. The organic disease identified was predominantly VSD (33.3%) and pulmonary stenosis (30.3%). Patients referred with abnormal investigations were diagnosed with organic disease in 55% of cases, predominantly VSD (20.4%) and ASD (16.9%).

Echocardiograms were performed in 60.6% of total consultations, and this was predicted by referral for a genetic concern (OR=4.7 [2.5-8.8]), having recently moved to the Maritimes with a cardiac condition (OR=4.6 [2.1-10.4]), and pediatric subspecialist referral (OR=1.9 [1.2-3.1]). Organic disease was predicted by pediatric subspecialist referral (OR=2.4 [1.5-3.9]), general pediatrician referral (OR=2.2 [1.6-3.0]), and referral for palpitations (OR=2.3 [1.4-3.7]).

Conclusion: The increasing rate of pediatric cardiology referrals raises concerns about accessibility and timeliness of cardiology care. This trend can partially be explained by increased referrals post COVID-19, and changes in referring patterns with primary clinician shortages across the Maritimes. These findings raise questions about the current model of care and whether model changes are required to improve accessibility to pediatric cardiology.