Background We compared outpatient practice in a tertiary cardiac unit in two time-cohorts to monitor changes to practice.

Aims To identify changing patterns of referrals to a tertiary paediatric cardiology unit, looking at diagnosis, and outcomes.

Methods A retrospective study looking at all referrals made to our unit by primary care and paediatricians in 6 months; the first cohort in 2006, the second in 2013. The hospital-based patient administration system and departmental database identified the new referrals. We recorded referring physicians, reason for referral, demographics, clinical data and outcomes.

Results 813 (2006) and >1200 (2013) children were identified; we excluded patients seen by us previously. In both the cohorts, the split between GP and paediatric referrals was similar (30:70). Common reasons for referral were asymptomatic heart murmurs, palpitations/suspected rhythm abnormalities, chest pain, syncope, non-central cyanosis, screening for family history, clinical syndromes and suspected congenital heart disease on clinical/echocardiography at a peripheral hospital. We looked at demographics, and outcomes between the two groups. We explored the relationship between primary and secondary level referrals, and outcomes.

Conclusions There is a sustained increase in number of outpatients to tertiary cardiology centres; majority of these have either no or a minor pathology that does not need any active management. These children can be seen by paediatricians with expertise in cardiology (PEC). Clinicians, Trusts and Health-commissioners need to react to this trend so as to increase, and improve the infrastructure and provide the necessary support to the physicians, ensure optimal patient care, and provide a suitable experience for families.