Cardiovascular risk factor screening and management of obese patients at an outpatient pediatric cardiology center.
OBJECTIVE
To evaluate documentation of cardiovascular (CV) risk factors and obesity management by pediatric cardiologists.


METHODS
Review of medical records of obese (≥95th body mass index percentile) 2-17 year-old children presenting to outpatient pediatric cardiology over 1 year. Subjects were categorized as:heart disease (HD) with increased risk for atherosclerosis;HD with average risk for atherosclerosis; or no HD. Data were evaluated on documentation of the assessment of seven CV risk factors [including recognition of elevated blood pressure (BP)] and management of obesity. Multivariable logistic regression (LR) examined physician documentation of obesity intervention by risk groups, including age and gender.


RESULTS
Data on 730 subjects were analyzed; 16 % hadHD with increased risk for atherosclerosis, 41 % hadHD with average risk for atherosclerosis, and 43 % had no HD. Documentation of risk factor assessment was highest for physical inactivity (53 %) and recognition of obesity (47 %). Other factors (child dyslipidemia, diet, dysglycemia, and cigarette exposure) were documented less frequently. Elevated BP was found in 144 patients (20 %); 53/144 (37 %) had documentation of elevated BP recognition. An obesity intervention was documented in 62 % of records and did not significantly differ between risk groups. In the multivariate LR, physician documentation of obesity intervention did not significantly differ between risk groups.


CONCLUSIONS
Complete assessment of CV risk factors in obese patients is low. The number of risk factors assessed was similar among patients withHD with average risk of atherosclerosisandHD with increased risk of atherosclerosis. Increased care coordination between cardiologists and primary care providers may lead to uniform, comprehensive CV risk assessment.
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 21, Chicago, IL 60611-2605 USA ; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA.
Margaret
0000-0003-3981-5701
M
Greco
Rosalind Franklin University, Chicago Medical School, North Chicago, IL USA.
Arun
A
Sood
Center on Obesity Management and Prevention, Mary Ann & J. Milburn Smith Child Health Research Program, Stanley Manne Children's Research Institute, Chicago, IL USA.
Soyang
S
Kwon
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 21, Chicago, IL 60611-2605 USA ; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA ; Center on Obesity Management and Prevention, Mary Ann & J. Milburn Smith Child Health Research Program, Stanley Manne Children's Research Institute, Chicago, IL USA.
Adolfo J
AJ
Ariza
BMI; Cardiovascular risk factors; Children; Congenital heart disease; Obesity; Pediatric