Factors Prompting Referral for Cardiology Evaluation of Heart Murmurs in Children

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Abstract
The outpatient evaluation of heart murmurs in children constitutes a major part of pediatric cardiology practice. Studies have shown that clinical assessment alone by a pediatric cardiologist has a high sensitivity and specificity for disease detection and that this practice is cost-effective.1-3 The increasing availability and use of echocardiography by other health care providers may alter referral patterns and ultimately the practices of pediatric cardiologists, as well as affect the cost-effectiveness of medical care.4 Factors currently prompting a provider to refer a child with a heart murmur for pediatric cardiology consultation are largely unknown. We sought to determine both clinical and nonclinical factors that may affect referral decisions and ultimately the practices of pediatric cardiologists. Methods. A mail questionnaire was sent to all eligible referring providers at the time of the request for an appointment for outpatient pediatric cardiology consultation at the Helen B. Taussig Children's Heart Center