title: Outcome of children [corrected] with heart murmurs referred from general practice to a paediatrician with expertise in cardiology.
abstract: BACKGROUND
  Heart murmurs are common in children. The majority are detected incidentally, and congenital heart disease is rare. There are no published United Kingdom guidelines for management of children with murmurs in primary care. Common practice is to refer all children for specialist assessment.
  
  
  OBJECTIVE
  To review outcomes of children with heart murmurs who were referred by general practitioners to a clinic conducted by a paediatrician with expertise in cardiology. Design and setting A retrospective review of children referred by general practitioners to a paediatrician with expertise in cardiology.
  
  
  METHODS
  Hospital records of all children under 17 years of age who attended the clinic during 2011 were reviewed. We excluded children previously seen by any cardiology service.
  
  
  RESULTS
  There were 313 new primary care referrals, with complete records available for 310 children. Of them, 186 (60%) were referred with a murmur: 154 for an asymptomatic murmur alone, and 32 for a murmur plus additional symptoms or family history of congenital heart disease. All underwent echocardiography. Of the patients, 38 (20%) had congenital heart disease. Younger children were more likely to have congenital heart disease. There was no difference between rates of congenital heart disease in children with or without symptoms or a family history.
  
  
  CONCLUSIONS
  The finding that a large proportion of children referred by general practitioners with asymptomatic heart murmurs have congenital heart disease supports current referral practice on clinical grounds.
authors.affiliation: 1Murray Edwards College,University of Cambridge,Huntingdon Road,Cambridge,United Kingdom.
authors.forename: Abha
authors.initials: A
authors.lastname: Khushu
authors.affiliation: 2NICU,Cambridge University Hospitals NHS Foundation Trust,Hills Road,Cambridge,United Kingdom.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kelsall
authors.affiliation: 3The Primary Care Unit,Strangeways Research Laboratory,University of Cambridge,Worts Causeway,Cambridge,United Kingdom.
authors.forename: Juliet A
authors.initials: JA
authors.lastname: Usher-Smith
mesh_terms: D000293:Adolescent; D002309:Cardiology / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D058006:General Practice; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006337:Heart Murmurs / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology