Current Trends in Fetal Cardiology: Results from an International Benchmarking Survey of Fetal Cardiac Programs Through the Fetal Heart Society Research Collaborative

Fetal cardiology has grown into a robust pediatric cardiology subspecialty in the last two decades, with many congenital heart centers having a dedicated fetal cardiac program. Despite the subspeciality's clear maturation, there are no multicenter data to describe volume, practice patterns, program structures, resources, or trends. The Fetal Heart Society sought to address this deficiency by conducting an international survey of fetal cardiac programs. A survey was distributed internationally to fetal cardiac programs. One response per institution or clinical practice was collected. Respondents were asked to provide data from the 2022 calendar year. Ninety-five programs responded, with the majority representing the United States of America (n = 75, 79%) or Canada (n = 11, 12%). Most responding programs (88%) had an academic or university affiliation, and 69% were from independent children's hospitals. The median number of fetal echocardiographic studies performed annually per program was 1,000 (IQR 580-2,100). There was a median of 5 (IQR 3-7) fetal cardiologists and 5 (IQR 3-7) sonographers per program. Each fetal cardiologist interpreted an estimated median of 6 (IQR 5-8) fetal studies in a full day shift. The most common duration allocated for each fetal echocardiographic study was 45-59 min for the initial study (51%) and 45-59 min for the follow-up study (42%). 79% of programs had a fetal cardiac nurse coordinator. An independent fetal database was maintained at 78% of programs. Less than half of programs (46/95) had a formal quality improvement (QI) initiative, with only 22 programs participating in national-level QI metrics. The most frequently reported barrier to having a fetal cardiac QI program was a lack of human resources (60%), followed by a lack of institutional support/incentive (41%). Programs were more likely to have a formal fetal cardiology QI program if they had a fetal cardiac coordinator (p = 0.0029) if they had a formal fetal database (p = 0.003), or if they were a larger volume program (p = 0.026). Certain subspecialties were available at most programs, including neonatology (93%), maternal-fetal medicine (88%), genetic counseling (88%), and social work (79%). However, psychology (38%) and psychiatry (16%) services to address parental mental health issues were not as commonly available. These survey data provide a novel and comprehensive view of fetal cardiology programs with information useful for internal benchmarking, quality improvement initiatives, resource allocation, and identifying unmet needs.