Aims Children are referred to paediatric secondary care by general practitioners (GPs) for numerous reasons. Cardiac complaints such as heart murmurs are common, and children with murmurs are referred for assessment which may include echocardiography. Given the increasing pressure to reduce referrals across all specialties, this study reviewed outcomes of GP referrals to a paediatrician with expertise in cardiology (PEC) to evaluate the use of echocardiography and provide guidance for GPs.
Methods We retrospectively reviewed electronic hospital records of children under 16 years old newly referred by NHS GPs to a local PEC clinic during 2011. We excluded children previously seen by any cardiology service.
Results Two hundred and seventy one children were referred, 165 (60%) were referred for investigation of a murmur: 137 for an asymptomatic murmur alone and 28 for a murmur plus either symptoms or family history of cardiac disease. All underwent echocardiography. 31 (19%) were diagnosed with congenital heart disease (CHD) of which 7 have required catheter or surgical intervention (4% of the new GP referrals for assessment of a murmur). Younger children with murmurs were more likely to have CHD: 9/24 (37.5%) children under 3 months, 9/39 (23%) children between 3 months and one year, 10/58 (17%) children between 1–5 years, 1/14 (7%) between 5–10 years and none over 10 years. Forty nine children (18%) were referred for a family history of cardiac problems (e.g. CHD, cardiomyopathy) with 1 child having CHD that has not needed intervention. Other complaints included chest pain (8), palpitations (19), cyanosis (4) and syncope/dizziness (9). None of these other presenting complaints had any underlying pathology.
Conclusion The finding that a large proportion of children referred by GPs with asymptomatic heart murmurs have CHD supports current GP referral practise and the use of echocardiography for assessing murmurs. Children with a murmur under 3 months of age have the highest risk of CHD. In this review other presenting complaints do not seem to have any associated life-threatening heart disease – these children might initially be safely managed in the community without echocardiography.