Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists
Background Results from multiple clinical trials support patent foramen ovale closure after cryptogenic stroke in select patients, but it remains unclear how new data and updated professional society guidelines have impacted clinical practice. Here, we aimed to compare how stroke neurologists and in...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.029451 |
| _version_ | 1797337877462384640 |
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| author | Farhan Khan Laith A. Derbas Steven R. Messé Clifford Kavinsky Scott E. Kasner Christopher G. Favilla |
| author_facet | Farhan Khan Laith A. Derbas Steven R. Messé Clifford Kavinsky Scott E. Kasner Christopher G. Favilla |
| author_sort | Farhan Khan |
| collection | DOAJ |
| description | Background Results from multiple clinical trials support patent foramen ovale closure after cryptogenic stroke in select patients, but it remains unclear how new data and updated professional society guidelines have impacted clinical practice. Here, we aimed to compare how stroke neurologists and interventional cardiologists approach patients with cryptogenic stroke with patent foramen ovale and how critical anatomic and clinical factors influence decision making. Methods and Results An electronic survey was administered to 1556 vascular neurologists and 1057 interventional cardiologists throughout the United States. The survey addressed factors such as patient age, preclosure workup, and postclosure antithrombotics. Clinical vignettes highlighted critical variables and used a 5‐point Likert scale to assess the providers' level of support for closure. There were 491 survey responses received from 301 (of 1556) vascular neurologists and 190 (of 1057) interventional cardiologists, with an overall response rate of 19%. Vascular neurologists were more likely to recommend against closure on the basis of older age (P<0.001). Interventional cardiologists are more supportive of closure across a range of clinical vignettes, including a very carefully selected patient with cryptogenic stroke (P<0.001), a patient with a high‐risk alternative stroke cause (P<0.001), and a range of cases highlighting clinical variables where data are lacking. The majority of interventionalists (88%) seek neurology consultation before pursuing patent foramen ovale closure. Conclusions lnterventional cardiologists are more likely than vascular neurologists to support patent foramen ovale closure across a range of situations. This emphasizes the importance of collaboration and shared decision making, but also reveals an opportunity for professional society educational outreach. |
| first_indexed | 2024-03-08T09:22:56Z |
| format | Article |
| id | doaj.art-662b7c53bf7d4311a75771d66dbfe9df |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-08T09:22:56Z |
| publishDate | 2023-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-662b7c53bf7d4311a75771d66dbfe9df2024-01-31T11:31:17ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-07-01121310.1161/JAHA.123.029451Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular NeurologistsFarhan Khan0Laith A. Derbas1Steven R. Messé2Clifford Kavinsky3Scott E. Kasner4Christopher G. Favilla5Department of Neurology University of Chicago Chicago IL USADivision of Cardiovascular Medicine Rush University Medical Center Chicago IL USADepartment of Neurology University of Pennsylvania Philadelphia PA USADivision of Cardiovascular Medicine Rush University Medical Center Chicago IL USADepartment of Neurology University of Pennsylvania Philadelphia PA USADepartment of Neurology University of Pennsylvania Philadelphia PA USABackground Results from multiple clinical trials support patent foramen ovale closure after cryptogenic stroke in select patients, but it remains unclear how new data and updated professional society guidelines have impacted clinical practice. Here, we aimed to compare how stroke neurologists and interventional cardiologists approach patients with cryptogenic stroke with patent foramen ovale and how critical anatomic and clinical factors influence decision making. Methods and Results An electronic survey was administered to 1556 vascular neurologists and 1057 interventional cardiologists throughout the United States. The survey addressed factors such as patient age, preclosure workup, and postclosure antithrombotics. Clinical vignettes highlighted critical variables and used a 5‐point Likert scale to assess the providers' level of support for closure. There were 491 survey responses received from 301 (of 1556) vascular neurologists and 190 (of 1057) interventional cardiologists, with an overall response rate of 19%. Vascular neurologists were more likely to recommend against closure on the basis of older age (P<0.001). Interventional cardiologists are more supportive of closure across a range of clinical vignettes, including a very carefully selected patient with cryptogenic stroke (P<0.001), a patient with a high‐risk alternative stroke cause (P<0.001), and a range of cases highlighting clinical variables where data are lacking. The majority of interventionalists (88%) seek neurology consultation before pursuing patent foramen ovale closure. Conclusions lnterventional cardiologists are more likely than vascular neurologists to support patent foramen ovale closure across a range of situations. This emphasizes the importance of collaboration and shared decision making, but also reveals an opportunity for professional society educational outreach.https://www.ahajournals.org/doi/10.1161/JAHA.123.029451closurepatent foramen ovalePFOPFO closurestroke |
| spellingShingle | Farhan Khan Laith A. Derbas Steven R. Messé Clifford Kavinsky Scott E. Kasner Christopher G. Favilla Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease closure patent foramen ovale PFO PFO closure stroke |
| title | Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists |
| title_full | Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists |
| title_fullStr | Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists |
| title_full_unstemmed | Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists |
| title_short | Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists |
| title_sort | management of patients with patent foramen ovale and stroke a national survey of interventional cardiologists and vascular neurologists |
| topic | closure patent foramen ovale PFO PFO closure stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.029451 |
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