Physicians' Self-reported Exercise Testing and Physical Activity Recommendations in Kawasaki Patients

Area of Science:

• Pediatric Cardiology
• Cardiovascular Health
• Rheumatology

Background:

• Kawasaki disease (KD) management guidelines recommend physical activity (PA) promotion for patients with coronary artery aneurysms (CAA).
• Current practices regarding exercise testing and PA recommendations for KD patients with CAA are not well-characterized.

Purpose of the Study:

• To assess the self-reported practices of pediatric cardiologists concerning cardiopulmonary exercise testing (CPET) and PA recommendations in KD patients with CAA.
• To identify practice variations among providers in managing PA for KD patients with varying degrees of CAA.

Main Methods:

• A REDCap survey was developed with clinical scenarios of KD patients.
• The survey was distributed to members of the International Kawasaki Disease Registry (IKDR) and community pediatric cardiologists.
• Twenty-eight physicians completed the survey, providing data on their management strategies.

Main Results:

• Most providers (93%) agreed that patients without CAA do not require CPET and can be cleared for all PA.
• Significant variation exists in CPET recommendations and PA clearance for patients with small, medium, and large/giant CAA, especially when aneurysms persist.
• A notable percentage of providers (19%) would restrict patients with persistent large/giant CAA from all physical education.

Conclusions:

• There is considerable practice variation in the use of CPET and PA recommendations for KD patients with CAA.
• Providers demonstrate hesitancy in promoting PA for KD patients with CAA, potentially due to concerns about residual aneurysms, despite established benefits and guidelines.