title: Variation in Cardiac Screening and Management of Carcinoid Heart Disease in the UK and Republic of Ireland.
abstract: OBJECTIVE
  Screening for carcinoid heart disease is an important, yet frequently neglected aspect of the management of patients with neuroendocrine tumours (NETs). Screening is advocated in international guidelines, although recommendations on the modality and frequency are poorly defined. We mapped current practice for the screening and management of carcinoid heart disease in specialist NET centres throughout the UK and Republic of Ireland.
  
  
  METHODS
  Thirty-five NET centres were invited to complete an online questionnaire outlining the size of NET service, patient selection criteria for carcinoid heart disease screening and the modality and frequency of screening.
  
  
  RESULTS
  Twenty-eight centres responded (80%), representing over 5500 patients. Eleven per cent of centres screen all patients with any NET, 14% screen only patients with midgut NETs, 32% screen all patients with liver metastases and/or carcinoid syndrome and 43% screen all patients with evidence of syndrome or raised urinary/serum/plasma 5-hydroxyindoleacetic acid (5HIAA). The mode of screening included clinical examination, echocardiography and biomarker measurement: 89% of centres carry out echocardiography, ranging from at initial presentation only (24%), periodically without clearly defined intervals (28%), annually (36%) or less than annually (12%); three centres use a scoring system to report their echocardiograms. Fifty per cent of centres utilise biomarkers for screening (chromogranins, plasma/urinary 5HIAA or most commonly N-terminal pro-brain natriuretic peptide) at varying time intervals.
  
  
  CONCLUSIONS
  There is considerable heterogeneity across the UK and Ireland in multiple aspects of screening and management of carcinoid heart disease.
authors.affiliation: Neuroendocrine Tumour Group, University Hospital Aintree, Liverpool, UK; Department of Obesity and Endocrinology, University of Liverpool, Clinical Sciences Building, University Hospital Aintree, Liverpool, UK. Electronic address: rebecca.dobson@liverpool.ac.uk.
authors.forename: R
authors.initials: R
authors.lastname: Dobson
authors.affiliation: Manchester Academic Health Sciences Centre, Department of Medical Oncology, The Christie NHS Foundation Trust, Withington, Manchester, UK.
authors.forename: J W
authors.initials: JW
authors.lastname: Valle
authors.affiliation: Neuroendocrine Tumour Group, University Hospital Aintree, Liverpool, UK.
authors.forename: M I
authors.initials: MI
authors.lastname: Burgess
authors.affiliation: Neuroendocrine Tumour Group, University Hospital Aintree, Liverpool, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Poston
authors.affiliation: Neuroendocrine Tumour Group, University Hospital Aintree, Liverpool, UK; Department of Obesity and Endocrinology, University of Liverpool, Clinical Sciences Building, University Hospital Aintree, Liverpool, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Cuthbertson
mesh_terms: D015415:Biomarkers / Q000032:analysis*; D002275:Carcinoid Heart Disease / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D019468:Disease Management; D004452:Echocardiography / Q000379:methods*; D006801:Humans; D007494:Ireland; D008113:Liver Neoplasms / Q000150:complications* / Q000556:secondary / Q000628:therapy; D008403:Mass Screening / Q000379:methods* / Q000639:trends; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000473:pathology / Q000628:therapy; D011159:Population Surveillance; D006113:United Kingdom
chemical_list: D015415:Biomarkers
keywords: Carcinoid heart disease; management; neuroendocrine; screening