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Physicians’ Self-reported Exercise Testing and Physical Activity Recommendations in Kawasaki Patients

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Abstract

Recommendations for management of patients with Kawasaki disease (KD) and coronary artery aneurysms (CAA) include physical activity (PA) promotion. This study aimed to characterize self-reported practices of KD providers to evaluate practice variation in use of cardiopulmonary exercise testing (CPET) and PA recommendations. We developed a REDCap survey with different clinical scenarios of KD patients. It was completed by members of the International Kawasaki Disease Registry (IKDR) and community pediatric cardiologists. Twenty-eight physicians responded; 63% practiced in the US, 63% practiced in an academic setting, 48% were general pediatric cardiologists, and 55% were IKDR members. Most respondents (69%) followed < 50 KD patients. The great majority (93%) agreed that patients with no CAA do not require CPET and could be cleared for all PA. For patients with small CAA, 43% of respondents recommended CPET and 75% cleared for all PA if CAAs regressed completely, but only 32% cleared if CAA persisted. For patients with medium CAA, 66% respondents cleared for PA if CAA regressed, and only 7% if CAA persisted; with 66% and 75% recommending CPET, respectively. For patients with large/giant CAA, 81% of respondents recommended CPET. No respondents felt comfortable clearing their patients with persistent large/giant CAA for PA and 19% would restrict from the entire physical education program. There is practice variation in use of CPET in KD patients with CAAs. Providers are hesitant to promote PA in KD patients with CAA despite known benefits and current guidelines.

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Abbreviations

KD:

Kawasaki disease

CAA:

Coronary artery aneurysm

CPET:

Cardiopulmonary exercise testing

IKDR:

International Kawasaki Disease Registry

AHA:

American Heart Association

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Acknowledgements

None.

Funding

This study was not supported by funding or sponsorship. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dr. Harahsheh is supported by a Sub-agreement from the Johns Hopkins University with funds provided by Grant No. R61HD105591 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development and the Office of the Director, National Institute of Health (OD). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development, the Office of the Director, National Institute of Health (OD), the National Institute of Health, the NIBIB, the NHLBI, or the Johns Hopkins University.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

    Katherine Hansen, Stafford Grady & Elif Seda Selamet Tierney

  2. Division of Cardiology, Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada

    Brian W. McCrindle

  3. Division of Pediatric Cardiology, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC, USA

    Ashraf S. Harahsheh

  4. Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Matthew D. Elias

  5. Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Canada

    Nagib Dahdah

Authors
  1. Katherine Hansen
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  2. Stafford Grady
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  3. Brian W. McCrindle
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  4. Ashraf S. Harahsheh
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  5. Matthew D. Elias
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  6. Nagib Dahdah
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  7. Elif Seda Selamet Tierney
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Contributions

KH and ESST conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, collected data, carried out the analysis, drafted the initial manuscript, and reviewed and revised the manuscript. SG conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, and reviewed and revised the manuscript. BWM, ASH, MDE, and ND contributed to developing the data collection instruments and reviewed and revised the manuscript.

Corresponding author

Correspondence to Katherine Hansen.

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The authors have no conflicts of interest relevant to this article to disclose.

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This study was approved by our internal review board.

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Consent to participate was obtained from all participants.

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All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Hansen, K., Grady, S., McCrindle, B.W. et al. Physicians’ Self-reported Exercise Testing and Physical Activity Recommendations in Kawasaki Patients. Pediatr Cardiol 44, 631–639 (2023). https://doi.org/10.1007/s00246-022-02984-z

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  • DOI: https://doi.org/10.1007/s00246-022-02984-z

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