Table 1.
Differences between the United Kingdom, United States, and Gulf countries with respect to key aspects of PFO management (based on 66 responses).
| Parameter | US (n = 19) | UK (n = 31) | Gulf (n = 16) | P value |
|---|---|---|---|---|
| Respondents' characteristics | ||||
| Experience (years) | 18 (10–20)∗ | 11 (10–15) | 5 (3–13)∗ | 0.004 |
| Population size of a PFO service | 1.5 (1–5)∗† | 3 (2–5)∗ | 5 (2–23)† | 0.002 |
| Interventional cardiologists (PFO operators) | 19 (100%)∗ | 31 (100%)† | 10 (63%)∗† | <0.001 |
| Annual volume | 40 (20–75)∗ | 40 (30–50)† | 10 (5–18)∗† | <0.001 |
|
| ||||
| Screening and patient selection | ||||
| No screening for thrombophilia | 5 (26%) | 6 (19%) | 2 (13%) | 0.616 |
| ≥7-day ECG monitoring to exclude AF including use of ICM | 18 (95%)∗† | 12 (39%)∗ | 7 (44%)† | <0.001 |
| PFO closure in patients older than 60-year-old | 18 (95%)∗ | 24 (77%) | 7 (44%)∗ | 0.002 |
| PFO closure in patients with typical TIA, high-risk features, and negative brain DW-MRI | 13 (68%) | 19 (61%) | 9 (56%) | 0.720 |
| PFO closure of left circulation thromboembolism other than stroke/TIA | 10 (53%)∗ | 28 (90%)∗† | 3 (19%)† | <0.001 |
| Occasional or regular use of the RoPE score | 15 (79%) | 14 (45%) | 13 (81%) | 0.013 |
| Routine TOE before PFO closure procedure | 13 (68%) | 16 (52%)∗ | 15 (94%)∗ | 0.009 |
| Availability of transcranial Doppler | 9 (47%) | 6 (19%) | 4 (25%) | 0.127 |
|
| ||||
| Procedure and follow-up | ||||
| Intraoperative use of ICE | 18 (95%)∗† | 11 (36%)∗ | 3 (19%)† | <0.001 |
| Continuation of single antiplatelet therapy for at least 5 years | 13 (68%) | 21 (68%) | 9 (63%) | 0.891 |
| Repeat bubble echocardiogram postdischarge | 16 (84%) | 24 (77%) | 10 (56%) | 0.170 |
|
| ||||
| Future directions | ||||
| PFO closure as a primary prevention | 0 (0%) | 6 (19%) | 3 (19%) | 0.050 |
| PFO closure for decompression sickness/migraine with aura/platypnea-orthodeoxia syndrome | 16 (84%)∗ | 30 (97%)† | 5 (31%)∗† | <0.001 |
Values are median (IQR) or n (%). ∗ and † denote the significant difference in post hoc pairwise comparison using Bonferroni correction at adjusted p value < 0.05. AF, atrial fibrillation; DW-MRI, diffusion-weighted magnetic resonance imaging; ECG, electrocardiogram; ICE, intracardiac echocardiography; ICM, insertable cardiac monitor; PFO, patent foramen ovale; RoPE, Risk of Paradoxical Embolism TOE, transoesophageal echocardiography; TIA, transient ischemic attack.