Clinicians' Approach to Patent Foramen Ovale Closure after Stroke: Comparing Cardiologists and Neurologists.
Clinicians' Approach to Patent Foramen Ovale Closure after Stroke: Comparing Cardiologists and Neurologists.
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DOI：
10.1161/jaha.122.025598
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发表时间：
2022-07-19
影响因子：
5.4
通讯作者：
Favilla, Christopher G.
中科院分区：
文献类型：
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作者：
Khan, Farhan;Fiorilli, Paul;Messe, Steven R.;Kasner, Scott E.;Derbas, Laith A.;Kavinsky, Clifford J.;Favilla, Christopher G.
来自随机试验和更新的专业学会指南的证据支持在选定患者中进行不明原因卒中后卵圆孔未闭（PFO）闭合。目前尚不清楚这是如何融入真实的世界实践的，因此我们旨在比较心脏病学家和神经科医生之间的实践模式。2021年3月，对在宾夕法尼亚大学卫生系统工作或之前接受过培训的心脏病学家和神经学家进行的一项调查评估了中风后PFO闭合的实践偏好。临床小插曲分离出感兴趣的特定变量，并使用5分Likert量表评估PFO闭合的支持水平。通过Wilcoxon-Mann-Whitney检验比较卒中神经科医生和介入心脏病学家。其次，Kruskal-Wallis检验比较了卒中神经科医生、普通神经科医生、介入心脏病学家和普通心脏病学家。我们收到了来自182名调查接受者的106份回复（31/31名卒中神经科医生，38/46名介入心脏病科医生，20/30名普通神经科医生和17/77名普通心脏病科医生）。相似比例的卒中神经学家和介入心脏病学家支持PFO闭合年轻隐源性卒中患者，分别为88%和87%（P=0.54）。在替代高风险卒中机制的背景下，介入医生比卒中神经科医生更可能支持闭合，分别为14%和0%（P=0.003）。卒中神经科医生更可能反对年龄较大的闭合（P=0.01）。神经科医生和心脏科医生在卒中后如何处理PFO闭合之间存在关键差异，特别是在解释卒中病因和考虑既往试验范围之外的闭合时;这强调了心脏科医生和神经科医生之间合作的重要性。
Evidence from randomized trials and updated professional society guidelines supports patent foramen ovale (PFO) closure after cryptogenic stroke in select patients. It is unclear how this has been integrated into real‐world practice, so we aimed to compare practice patterns between cardiologists and neurologists. In March of 2021, a survey of cardiologists and neurologists who work or previously trained at the University of Pennsylvania Health System assessed practice preferences with respect to PFO closure after stroke. Clinical vignettes isolated specific variables of interest and used a 5‐point Likert scale to assess the level of support for PFO closure. Stroke neurologists and interventional cardiologists were compared by Wilcoxon‐Mann–Whitney tests. Secondarily, Kruskal–Wallis tests compared stroke neurologists, general neurologists, interventional cardiologists, and general cardiologists. We received 106 responses from 182 survey recipients (31/31 stroke neurologists, 38/46 interventional cardiologists, 20/30 general neurologists, and 17/77 general cardiologists). A similar proportion of stroke neurologists and interventional cardiologists favored PFO closure in a young patient with cryptogenic stroke, 88% and 87%, respectively (P=0.54). Interventionalists were more likely than stroke neurologists to support closure in the context of an alternative high‐risk stroke mechanism, 14% and 0%, respectively (P=0.003). Stroke neurologists were more likely to oppose closure on the basis of older age (P=0.01). There are key differences between how neurologists and cardiologists approach PFO closure after stroke, particularly when interpreting the stroke etiology and when considering closure beyond the scope of prior trials; this underscores the importance of collaboration between cardiologists and neurologists.