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Qin J, Chan CW, Dong J, Homma S, Ye S. Telemedicine is associated with reduced socioeconomic disparities in outpatient clinic no-show rates. J Telemed Telecare 2024; 30:1507-1515. [PMID: 36974422 DOI: 10.1177/1357633x231154945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION The global pandemic caused by coronavirus (COVID-19) sped up the adoption of telemedicine. We aimed to assess whether factors associated with no-show differed between in-person and telemedicine visits. The focus is on understanding how social economic factors affect patient no-show for the two modalities of visits. METHODS We utilized electronic health records data for outpatient internal medicine visits at a large urban academic medical center, from February 1, 2020 to December 31, 2020. A mixed-effect logistic regression was used. We performed stratified analysis for each modality of visit and a combined analysis with interaction terms between exposure variables and visit modality. RESULTS A total of 111,725 visits for 72,603 patients were identified. Patient demographics (age, gender, race, income, partner), lead days, and primary insurance were significantly different between the two visit modalities. Our multivariable regression analyses showed that the impact of sociodemographic factors, such as Medicaid insurance (OR 1.23, p < 0.01 for in-person; OR 1.03, p = 0.57 for telemedicine; p < 0.01 for interaction), Medicare insurance (OR 1.11, p = 0.04 for in-person; OR 0.95, p = 0.32 for telemedicine; p = 0.03 for interaction) and Black race (OR 1.36, p < 0.01 for in-person; OR 1.20, p < 0.01 for telemedicine; p = 0.03 for interaction), on increased odds of no-show was less for telemedicine visits than for in-person visits. In addition, inclement weather and younger age had less impact on no-show for telemedicine visits. DISCUSSION Our findings indicated that if adopted successfully, telemedicine had the potential to reduce no-show rate for vulnerable patient groups and reduce the disparity between patients from different socioeconomic backgrounds.
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Affiliation(s)
- Jimmy Qin
- Decision, Risk, and Operations Division, Columbia Business School, New York, USA
| | - Carri W Chan
- Decision, Risk, and Operations Division, Columbia Business School, New York, USA
| | - Jing Dong
- Decision, Risk, and Operations Division, Columbia Business School, New York, USA
| | - Shunichi Homma
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Siqin Ye
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
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Kaemmerer H, Diller GP, Achenbach S, Dähnert I, Eichstaedt CA, Eicken A, Freiberger A, Freilinger S, Geiger R, Gorenflo M, Grünig E, Hager A, Huntgeburth M, Kaemmerer-Suleiman AS, Kozlik-Feldmann R, Lammers AE, Nagdyman N, Michel S, Schmidt KH, Uebing A, von Scheidt F, Apitz C. [Pulmonary hypertension in adults with congenital heart disease in light of the 2022-ESC-PAH guidelines - Part II: Supportive therapy, special situations (pregnancy, contraception, non-cardiac surgery), targeted pharmacotherapy, organ transplantation, special management (shunt lesions, left ventricular disorders, univentricular hearts), interventions, intensive care, follow-up, future perspectives]. Pneumologie 2024; 78:566-577. [PMID: 38788761 DOI: 10.1055/a-2274-1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The number of adults with congenital heart defects (CHD) is steadily rising and amounts to approximately 360,000 in Germany. CHD is often associated with pulmonary hypertension (PH), which may develop early in untreated CHD. Despite timely treatment of CHD, PH not infrequently persists or recurs in older age and is associated with significant morbidity and mortality.The revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of "adults with congenital heart disease" is addressed only relatively superficial in these guidelines. Therefore, in the present article, this topic is commented in detail from the perspective of congenital cardiology.
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Affiliation(s)
- Harald Kaemmerer
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Gerhard Paul Diller
- Klinik für Kardiologie III: angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Münster, Deutschland
| | - Stephan Achenbach
- Universitätsklinik Erlangen, Medizinische Klinik 2 - Kardiologie und Angiologie, Erlangen, Deutschland
| | - Ingo Dähnert
- Universitätsklinik für Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Christina A Eichstaedt
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland; Institut für Humangenetik, Universität Heidelberg, INF 366, TLRC am DZL Heidelberg, Deutschland
| | - Andreas Eicken
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Annika Freiberger
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Sebastian Freilinger
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Ralf Geiger
- Univ.-Klinik für Pädiatrie III, Kardiologie, Pneumologie, Allergologie, Cystische Fibrose, Innsbruck, Österreich
| | - Matthias Gorenflo
- Klinik für Kinderkardiologie und angeborene Herzfehler, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland; Institut für Humangenetik, Universität Heidelberg, INF 366, TLRC am DZL Heidelberg, Deutschland
| | - Alfred Hager
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Michael Huntgeburth
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | | | - Rainer Kozlik-Feldmann
- Klinik und Poliklinik für Kinderkardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Deutschland
| | - Astrid E Lammers
- Klinik für Pädiatrische Kardiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Münster, Deutschland
| | - Nicole Nagdyman
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Sebastian Michel
- LMU Klinikum, Herzchirurgische Klinik und Poliklinik, Sektion für Chirurgie angeborener Herzfehler und Kinderherzchirurgie, Campus Großhadern, München, Deutschland
| | - Kai Helge Schmidt
- Universitätsmedizin Mainz, Zentrum für Kardiologie - Kardiologie I, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Anselm Uebing
- Universitätsklinikum Schleswig-Holstein, Klinik für angeborene Herzfehler und Kinderkardiologie, Kiel, Deutschland
| | - Fabian von Scheidt
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Christian Apitz
- Sektion Pädiatrische Kardiologie, Universitätsklinik für Kinder- und Jugendmedizin Ulm, Ulm, Deutschland
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Wray J, Pagel C, Coats L, Chester AH, Kennedy F, Crowe S. What does good care look like to people living with congenital heart disease in the 21st century? Qualitative online, asynchronous discussion forums. BMJ Open 2024; 14:e079691. [PMID: 38955366 PMCID: PMC11218017 DOI: 10.1136/bmjopen-2023-079691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/30/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES As part of a wider study, our aim was to elicit perspectives of people with congenital heart disease (CHD) and/or their parents/carers about their experiences of healthcare and what is important to them when receiving care. DESIGN AND SETTING A qualitative study involving a series of closed, asynchronous, online discussion forums underpinned by an interpretivist framework and set up and moderated by three patient charities via their Facebook pages. PARTICIPANTS People with CHD and parents/carers of people with CHD from the UK. RESULTS Five forums were run for 12-24 weeks across the three charities, and 343 participants signed up to the forums. Four linked themes related to processes of care were identified following thematic analysis of the transcripts: relationships and communication; access and coordination; experience of discrete episodes of care and psychological support. These impacted how care was experienced and, for some patients, outcomes of CHD and its treatment as well as broader health outcomes. In addition, context relating to stages of the patient journey was described, together with patient-related factors such as patients' knowledge and expertise in their own condition. CONCLUSIONS People with CHD and their parents/carers want individualised, person-centred care delivered within an appropriately resourced, multidisciplinary service. Although examples of excellent care were provided it is evident that, from the perspective of patients and parents/carers, some National Health Service Standards for people with CHD were not being met.
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Affiliation(s)
- Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Louise Coats
- Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Zaidi AH, Saleeb SF, Gurvitz M, Bucholz E, Gauvreau K, Jenkins KJ, de Ferranti SD. Social Determinants of Health Including Child Opportunity Index Leading to Gaps in Care for Patients With Significant Congenital Heart Disease. J Am Heart Assoc 2024; 13:e028883. [PMID: 38353239 PMCID: PMC11010070 DOI: 10.1161/jaha.122.028883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/11/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Gaps in care (GIC) are common for patients with congenital heart disease (CHD) and can lead to worsening clinical status, unplanned hospitalization, and mortality. Understanding of how social determinants of health (SDOH) contribute to GIC in CHD is incomplete. We hypothesize that SDOH, including Child Opportunity Index (COI), are associated with GIC in patients with significant CHD. METHODS AND RESULTS A total of 8554 patients followed at a regional specialty pediatric hospital with moderate to severe CHD seen in cardiology clinic between January 2013 and December 2015 were retrospectively reviewed. SDOH factors including race, ethnicity, language, and COI calculated based on home address and zip code were analyzed. GIC of >3.25 years were identified in 32% (2709) of patients. GIC were associated with ages 14 to 29 years (P<0.001), Black race or Hispanic ethnicity (P<0.001), living ≥150 miles from the hospital (P=0.017), public health insurance (P<0.001), a maternal education level of high school or less (P<0.001), and a low COI (P<0.001). Multivariable analysis showed that GIC were associated with age ≥14 years, Black race or Hispanic ethnicity, documenting <3 caregivers as contacts, mother's education level being high school or less, a very low/low COI, and insurance status (C statistic 0.66). CONCLUSIONS One-third of patients followed in a regional referral center with significant CHD experienced a substantial GIC (>3.25 years). Several SDOH, including a low COI, were associated with GIC. Hospitals should adopt formal GIC improvement programs focusing on SDOH to improve continuity of care and ultimately overall outcomes for patients with CHD.
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Affiliation(s)
- Abbas H. Zaidi
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
- Present address:
Nemours Children's Hospital‐DelawareWilmingtonDE
| | - Susan F. Saleeb
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Michelle Gurvitz
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Emily Bucholz
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
- Present address:
University of Colorado DenverDenverCO
- Present address:
Children’s Hospital ColoradoAuroraCO
| | - Kimberlee Gauvreau
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Kathy J. Jenkins
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Sarah D. de Ferranti
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
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Wright B, Fassler C, Tumin D, Sarno LA. Health System Encounters after Loss to Cardiology Follow-Up among Patients with Congenital Heart Disease. J Pediatr 2024; 268:113931. [PMID: 38311237 DOI: 10.1016/j.jpeds.2024.113931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To analyze receipt of care at other locations within a single rural academic health system after loss to follow-up in a cardiology clinic. STUDY DESIGN Patients with congenital heart defects seen in the clinic during 2018 and subsequently lost to cardiology follow-up were included in the study. We defined loss to follow-up as not being seen in the clinic for at least 6 months past the most recently recommended follow-up visit. Subsequent visits to other locations, including other subspecialty clinics, primary care clinics, the emergency department, and the hospital, were tracked through 2020. RESULTS Of 235 patients (median age 7 years, 136/99 female/male), 96 (41%) were seen elsewhere in the health system. Of 96 patients with any follow-up, 40 were seen by a primary care provider and 46 by another specialist; 44 were seen in the emergency department and 12 more were hospitalized. Patients with medical comorbidities or Medicaid insurance and those living closer to the clinic were more likely to continue receiving care within the same health system. CONCLUSIONS Patients with congenital heart defect are frequently lost to cardiology follow-up. Our study supports collaboration across specialties and between cardiology clinics and affiliated emergency departments to identify patients with congenital heart defect who have been lost to cardiology follow-up but remain within the health system. A combination of in-person and remote outreach to these patients may help them continue cardiology care.
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Affiliation(s)
- Brandon Wright
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Carly Fassler
- Brody School of Medicine at East Carolina University, Greenville, NC
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Lauren A Sarno
- Division of Pediatric Cardiology, Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC.
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Chaudhry I, Ghassani A, Wray J, Chaudhry B, Coats L. Outpatient care of adults with congenital heart disease in the UK: a qualitative appraisal of the clinician perspective. Open Heart 2024; 11:e002420. [PMID: 38286570 PMCID: PMC10826567 DOI: 10.1136/openhrt-2023-002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/11/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE This study aimed to explore clinicians' perspectives of ambulatory care in adult congenital heart disease (ACHD). METHODS Semistructured interviews were carried out remotely (Zoom) with a range of physicians providing ambulatory care to patients with ACHD across the UK. The chronic care model, thrive and candidacy frameworks were used to design prompt guides and subsequently develop themes. A framework approach was used to code and analyse transcripts, which were managed in NVivo. RESULTS 21 clinicians (43% females, 38% specialists) from 10/12 ACHD networks in the UK participated. Shared themes included the purpose of the clinic appointment, problems in the 'hub-and-spoke' care system, role of the general practitioner and ACHD specialist nurse, communication with patients, burden of ambulatory care and patient self-management. Reflecting on these themes, participants identified resources, what care and how and by it is delivered alongside the role of the patient as key areas for future research. CONCLUSIONS The present structure of ACHD ambulatory care is neither patient-centred nor equitable. The concerned clinicians raise the question whether increasing resource alone without changing structure will lead to better outcomes for patients.
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Affiliation(s)
- Isobel Chaudhry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anisa Ghassani
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, UCL, London, UK
| | - Bill Chaudhry
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Coats
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Adult Congenital Heart Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Alonso-Gonzalez R. When Fontan circulation is not the only strategy. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:17-18. [PMID: 37544591 DOI: 10.1016/j.rec.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Rafael Alonso-Gonzalez
- Toronto ACHD Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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Rottermann K, Doll U, Pfenning S, Reichenbach M, Fey D, Dobler A, Siauw C, Reif F, Gnibl J, Cesnjevar R, Dittrich S. The Congenital Cardiology Cloud - optimizing long-term care by connecting ambulatory and hospital medical attendance via telemedicine. KLINISCHE PADIATRIE 2024; 236:16-23. [PMID: 37683668 PMCID: PMC10803177 DOI: 10.1055/a-2154-6659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Patients with complex congenital heart disease frequently undergo a life-long ambulatory therapy with the need for repeated hospital interventions. To optimize this manifold interplay, we designed and implemented a tele-medical service, the Congenital Cardiology Cloud (CCC). This study aims to analyse the requirements for its implementation through the comprehensive assessment of design, installation and impact on patient´s care. METHODS CCC's development comprised the analysis of historically raised admission and discharge management and the definition of technical and organizational requirements. Elaboration of procedural flow charts, description of data formats and technical processes as well as distribution of patient structure formed part of this process. RESULTS Analysis of existing workflows uncovered a need for the rebuilding of admission and discharge process and decision making for further treatment. The CCC reduces conference-meetings in general and repetitive meetings up to less than a third. Real-time dispatch of discharge documents guarantees an instantaneous access to patient-related data. Comparative analyses show a more complex patient group to be involved in tele-medical services. CONCLUSIONS The CCC enables the sharing of complex clinical information by overcoming sectoral barriers and improves mutual patient advice. Implementation of a tele-medical network requires willingness, perseverance and professional engagement. Future application analysis and possible introduction of refinancing concepts will show its long-term feasibility.
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Affiliation(s)
| | - Ulrike Doll
- Department of Pediatric Cardiology, FAU, Erlangen,
Germany
| | - Simon Pfenning
- Department of Computer Science, Chair for Computer Architecture, FAU,
Erlangen, Germany
| | - Marc Reichenbach
- Department of Computer Science, Chair for Computer Architecture, FAU,
Erlangen, Germany
| | - Dietmar Fey
- Department of Computer Science, Chair for Computer Architecture, FAU,
Erlangen, Germany
| | | | - Céline Siauw
- Department of Pediatrics, University Hospital Würzburg,
Würzburg, Germany
| | - Fabian Reif
- Practice for Pediatric Cardiology, Ambulatory Practice, Nuremberg,
Germany
| | - Julia Gnibl
- Chair of Education with a Focus on Organizational Education, FAU,
Erlangen, Germany
| | - Robert Cesnjevar
- Department of Pediatric Heart Surgery, University of Zurich, Zurich,
Switzerland
| | - Sven Dittrich
- Department of Pediatric Cardiology, FAU, Erlangen,
Germany
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10
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Lee MGY, Russo JJ, Ward J, Wilson WM, Grigg LE. Impact of Telehealth on Failure to Attend Rates and Patient Re-Engagement in Adult Congenital Heart Disease Clinic. Heart Lung Circ 2023; 32:1354-1360. [PMID: 37821262 DOI: 10.1016/j.hlc.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic paved the way for telehealth consultations. We aimed to determine the impact of telehealth on rates of failure to attend (FTA) in adult congenital heart disease (ACHD) clinics and whether telehealth could re-engage patients with previous FTA face-to-face appointments. METHODS This was a retrospective audit of a tertiary ACHD clinic over a 12-month pre-telehealth (26 March 2019-17 March 2020) and 12-month post-telehealth implementation period (24 March 2020-16 March 2021). Patients with one or more FTAs during the 24-month study period were included. Our ACHD clinic is run three times per month. Patients with ACHD are offered lifelong follow-up and reviewed annually on average. Re-engagement was defined as two or more consecutive face-to-face FTAs immediately before the telehealth period with subsequent attendance of their telehealth appointment. RESULTS A total of 359 patients with a total of 623 FTAs were included. Complexity of congenital heart disease was moderate in 56% (202/359) and severe in 19% (69/359) of patients. Overall FTA rate was 18% (623/3,452). FTA rate was significantly lower in the post-telehealth period (15%, 257/1,664) compared with the pre-telehealth period (20%, 366/1,788) (p<0.00001). At study conclusion, 1% of patients had died (5/359). Of the 354 remaining patients, 42% (150/354) were considered lost to follow-up (two or more FTAs including telehealth), 37% (132/354) missed only one clinic appointment, and 20% (72/354) previously considered lost to follow-up had re-engaged in the telehealth period. CONCLUSIONS Rates of FTA in a tertiary ACHD clinic significantly reduced after the introduction of telehealth consultation. A fifth of patients considered lost to follow-up were re-engaged with telehealth. Additional strategies to further reduce FTA should be explored.
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Affiliation(s)
- Melissa G Y Lee
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia; Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.
| | - Jeremy J Russo
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Juliet Ward
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - William M Wilson
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
| | - Leeanne E Grigg
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
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Agarwal MA, Opotowsky A. The Long and Winding Road to Adults With Congenital Heart Disease Clinic: Examining Adult Congenital Clinic Nonattendance. Am J Cardiol 2023; 203:515-517. [PMID: 37544798 DOI: 10.1016/j.amjcard.2023.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Manyoo A Agarwal
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Alexander Opotowsky
- Cincinnati Children's Hospital, Heart Institute, Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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12
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McGrath L, Patel K, Colina Garcia I, Shalen E, Burton Y, Khan A. Factors Associated With Nonattendance at the Adult Congenital Heart Disease Clinic. Am J Cardiol 2023; 201:247-251. [PMID: 37393726 DOI: 10.1016/j.amjcard.2023.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
Adults with congenital heart disease (CHD) are a complex population for whom adult CHD-specific care results in better outcomes. Our objective was to identify factors associated with no-shows and cancelations in an adult CHD (ACHD) clinic and evaluate the efficacy of a social worker intervention to promote ambulatory follow-up. The medical record identified adults with a scheduled appointment in the adult CHD clinic from January 2017 to March 2021. Social worker intervention was performed between March 2020 and May 2021 and consisted of phone calls to those who did not show up. Logistic regression and descriptive statistics were performed. Of 8,431 scheduled visits, 56.7% were completed, 4.6% were no-shows, and 17.5% were canceled by patients. The factors associated with no-shows were Medicaid (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.26 to 2.12, p <0.001), previous no-show (OR per 1% increase in previous no-show rate 1.13, 95% CI 1.12 to 1.15, p <0.001), satellite clinic location (OR 3.15, 95% CI 2.06 to 4.74, p <0.001), virtual visit (OR 1.97, 95% CI 1.28 to 2.92, p = 0.001), and Hispanic ethnicity (OR 1.48, 95% CI 1.03 to 2.10, p = 0.031). The factors associated with cancelations were female gender (OR 1.45, 95% CI 1.25 to 1.68, p <0.001) and virtual visits (OR 2.24, 95% CI 1.50 to 3.40, p <0.001). Social worker outreach calls did not impact frequency of rescheduling. No patients accepted additional support. In conclusion, Medicaid insurance, previous number of no-shows, and Hispanic ethnicity were found to be associated with a higher risk of no-show, identifying a high-risk population that may benefit from targeted interventions. Social worker outreach did not have an appreciable impact on the rescheduling rates.
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Affiliation(s)
- Lidija McGrath
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
| | - Karishma Patel
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Ibett Colina Garcia
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Evan Shalen
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Yunwoo Burton
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Abigail Khan
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
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13
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Rustam LB, Vander Weg M, Chrischilles E, Tanaka T. Sociodemographic and Clinical Factors Associated with Nonattendance at the Hepatology Clinic. Dig Dis Sci 2023; 68:2398-2405. [PMID: 37106247 DOI: 10.1007/s10620-023-07951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Absenteeism from clinic appointments reduces efficiency, wastes resources, and contributes to longer wait times. There are limited data regarding factors associated with nonattendance in hepatology clinics. Identifying factors related to appointment nonattendance may help in the design of interventions for reducing absenteeism. METHODS We aim to identify sociodemographic, clinical, and appointment-related factors associated with absenteeism following referral to a liver clinic in a tertiary academic center located in the US Midwest. We designed a case-control study using data from electronic medical records of patients scheduled for appointments between January 2016 and December 2021. Cases were defined as patients who canceled appointments on the same day or resulting in no-shows, and controls were those who completed the referral visit. Information about patients' sociodemographic characteristics, appointment details, and etiology of liver disease were recorded. Hierarchical logistic regression was used to analyze factors related to nonattendance. RESULTS Of 3404 scheduled appointments, 460 (13.5%) missed visits were recorded. In the multivariable logistic regression models, hepatitis C and alcohol-associated liver disease were associated with greater odds of nonattendance [odds ratio (OR) 4.0 (95% CI 3.2-4.9), OR 2.7 (1.7-4.2), respectively] compared to those with other liver disease. Sociodemographic characteristics associated with risk of nonattendance included being Black [OR 2.6, (1.8-3.7)], Medicaid insurance or no insurance [OR 2.3 (1.7-2.9), OR 2.5 (1.6-3.7), respectively], non-English speaking [OR 1.8 (1.1-3.1)], being unmarried [OR 1.8 (1.4-2.2)], and longer wait time (> 30 days) until appointments [OR 1.8 (1.5-2.2)]. CONCLUSION Several sociodemographic and administrative characteristics, as well as hepatitis C and alcohol-associated liver disease were associated with appointment nonattendance. Targeted future interventions may help to decrease nonattendance.
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Affiliation(s)
- Louma Basma Rustam
- Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Mark Vander Weg
- University of Iowa College of Public Health, Iowa City, USA
- Iowa City VA Health Care System, Iowa City, USA
| | | | - Tomohiro Tanaka
- Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
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14
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1446] [Impact Index Per Article: 1446.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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15
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Espuny Pujol F, Franklin RC, Crowe S, Brown KL, Swan L, Pagel C, English KM. Transfer of congenital heart patients from paediatric to adult services in England. Heart 2022; 108:1964-1971. [PMID: 35794015 DOI: 10.1136/heartjnl-2022-321085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/16/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study assessed the transfer of patients from paediatric cardiac to adult congenital heart disease (ACHD) services in England and the factors impacting on this process. METHODS This retrospective cohort study used a population-based linked data set (LAUNCHES QI data set: 'Linking Audit and National datasets in Congenital Heart Services for Quality Improvement') including all patients born between 1987 and 2000, recorded as having a congenital heart disease (CHD) procedure in childhood. Hospital Episode Statistics data identified transfer from paediatric to ACHD services between the ages of 16 and 22 years. RESULTS Overall, 63.8% of a cohort of 10 298 patients transferred by their 22nd birthday. The estimated probability of transfer by age 22 was 96.5% (95% CI 95.3 to 97.7), 86.7% (95% CI 85.6 to 87.9) and 41.0% (95% CI 39.4 to 42.6) for severe, moderate and mild CHD, respectively. 166 patients (1.6%) died between 16 and 22 years; 42 of these (0.4%) died after age 16 but prior to transfer. Multivariable ORs in the moderate and severe CHD groups up to age 20 showed significantly lower likelihood of transfer among female patients (0.87, 95% CI 0.78 to 0.97), those with missing ethnicity data (0.31, 95% CI 0.18 to 0.52), those from deprived areas (0.84, 95% CI 0.72 to 0.98) and those with moderate (compared with severe) CHD (0.30, 95% CI 0.26 to 0.35). The odds of transfer were lower for the horizontal compared with the vertical care model (0.44, 95% CI 0.27 to 0.72). Patients who did not transfer had a lower probability of a further National Congenital Heart Disease Audit procedure between ages 20 and 30 compared with those who did transfer: 12.3% (95% CI 5.1 to 19.6) vs 32.5% (95% CI 28.7 to 36.3). CONCLUSIONS Majority of patients with moderate or severe CHD in England transfer to adult services. Patients who do not transfer undergo fewer elective CHD procedures over the following decade.
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Affiliation(s)
| | - Rodney C Franklin
- Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, UCL, London, UK
| | - Kate L Brown
- Cardiorespiratory, GOSH, London, UK.,Heart and Lung Division, Great Ormond Street Hospital NIHR Biomedical Research Centre', London, UK
| | - Lorna Swan
- Adult Congenital Heart Disease, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Kate M English
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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16
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Coats L, Chaudhry B. Ambulatory Care in Adult Congenital Heart Disease-Time for Change? J Clin Med 2022; 11:jcm11072058. [PMID: 35407666 PMCID: PMC9000074 DOI: 10.3390/jcm11072058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. METHODS A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, median ACHD AP class 2B) between 2014 and 2019 and the COVID-19 restrictions period (March 2020-July 2021). RESULTS Between 2014 and 2019, there were 575 appointments. Nonattendance was 10%; 15 patients recurrently nonattended. Eighty percent of appointments resulted in no decision other than continued review. Electrocardiograms and echocardiograms were frequent, but new findings were rare (5.1%, 4.0%). Decision-making was more common with the higher ACHD AP class and symptoms. Emergency admissions (n = 40) exceeded elective (n = 25), with over half following unremarkable clinic appointments. Distance travelled to the ACHD clinic was 14.9 km (1.6-265), resulting in 433-564 workdays lost. During COVID 19, there were 127 appointments (56% in-person, 41% telephone and 5% video). Decisions were made at 37% in-person and 19% virtual consultations. Nonattendance was 3.9%; there were eight emergency admissions. CONCLUSION The main purpose of the ACHD clinic is surveillance. Presently, the clinic does not sufficiently predict or prevent emergency hospital admissions and is costly to patient and provider. COVID-19 has enforced different methods for delivering care that require further evaluation.
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Affiliation(s)
- Louise Coats
- Adult Congenital Heart Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Correspondence:
| | - Bill Chaudhry
- Bioscience Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
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17
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Abstract
INTRODUCTION Adults with congenital heart disease (CHD) face a unique set of medical, psychological, and social challenges, and access to specialised adult congenital heart disease care has been associated with improved outcomes. Rural adults with CHD may represent a uniquely disadvantaged group given additional challenges when accessing specialised care. The aim of this study was to investigate the challenges faced by adults with CHD in accessing outpatient cardiac care, with a specific focus on understanding differences between urban- and rural-dwelling patients. METHODS This cross-sectional, survey-based study took place in the adult congenital heart disease clinic at an urban academic medical center. Additional medical information was abstracted in a retrospective manner from the electronic health record. In addition to descriptive statistics, t-tests and Chi-square tests were performed to investigate differences between urban and rural dwelling patients. RESULTS A total of 100 patients participated in the study (mean age 40 ± 13 years, 60% female, 18% rural dwelling). Across the total sample, the median driving distance to clinic was 20 miles (interquartile range 12-77); it was 15 miles for urban dwellers and 77 miles for rural dwelling patients (p < 0.001). The most commonly identified barriers to cardiac clinic visits were financial losses related to taking time off from work (39%), distance of clinic from home (33%), and weather (33%). Compared to urban dwelling patients, on average those who were rural dwelling had a lower level of education (p = 0.04), more difficulty paying insurance premiums (p < 0.001) and copays (p = 0.005), and were more likely to identify the distance from clinic (p = 0.05) and having to go into the city (p = 0.02) as barriers to clinic appointments. CONCLUSIONS The financial impact and distance to clinic were the most commonly identified barriers to outpatient cardiac care in this cohort of adults with CHD. These barriers, along with difficulty paying insurance premiums, are more common in rural dwelling patients. Initiatives such as telemedicine visits or providing financial subsidies for travel and treatment could help to expand specialty adult congenital heart disease care and better serve this growing patient population.
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18
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Khan AM, McGrath LB, Ramsey K, Agarwal A, Slatore CG, Broberg CS. Distance to Care, Rural Dwelling Status, and Patterns of Care Utilization in Adult Congenital Heart Disease. Pediatr Cardiol 2022; 43:532-540. [PMID: 34705069 DOI: 10.1007/s00246-021-02750-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
Many patients with adult congenital heart disease (ACHD) do not receive guideline-directed care. While distance to an ACHD center has been identified as a potential barrier to care, the impact of distance on care location is not well understood. The Oregon All Payer All Claims database was queried to identify subjects 18-65 years who had a health encounter from 2010 to 2015 with an International Classification of Diseases-9 code consistent with ACHD. Residence area was classified using metropolitan statistical areas and driving distance was queried from Google Maps. Utilization rates and percentages were calculated and odds ratios were estimated using negative binomial and logistic regression. Of 10,199 identified individuals, 52.4% lived < 1 h from the ACHD center, 37.5% 1-4 h, and 10.1% > 4 h. Increased distance from the ACHD center was associated with a lower rate of ACHD-specific follow-up [< 1 h: 13.0% vs. > 4 h: 5.0%, adjusted OR 0.32 (0.22, 0.48)], but with more inpatient, emergency room, and outpatient visits overall. Those who more lived more than 4 h from the ACHD center had less inpatient visits at urban hospitals (55.5% vs. 93.9% in those < 1 h) and the ACHD center (6.2% vs. 18.2%) and more inpatient admissions at rural or critical access hospitals (25.5% vs. 1.9%). Distance from the ACHD center was associated with a decreased probability of ACHD follow-up but higher health service use overall. Further work is needed to identify strategies to improve access to specialized ACHD care for all individuals with ACHD.
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Affiliation(s)
- Abigail M Khan
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, 97239, USA.
| | - Lidija B McGrath
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Katrina Ramsey
- Department of Biostatistics, Oregon Health & Science University, Portland, OR, USA
| | - Anushree Agarwal
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.,Division of Pulmonary & Critical Care Medicine, Department of Medicine, and Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, USA
| | - Craig S Broberg
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, 97239, USA
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19
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2620] [Impact Index Per Article: 1310.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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20
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Akkermann S, Halling T, Löffler F, Silber-Peest AS, Krüger T, Bleich S, Bauersachs J, Kahl KG, Westhoff-Bleck M. Impact of COVID-19 on Medical Supply in Adults With Congenital Heart Disease. Front Psychiatry 2022; 13:812611. [PMID: 35370818 PMCID: PMC8968127 DOI: 10.3389/fpsyt.2022.812611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In March 2020, the World Health organization declared COVID-19 a global pandemic. One year later, the direct and indirect burden of the COVID-19 pandemic become more visible. In this context, there is concern about the allocation of medical resources and medical treatment of other diseases than COVID-19. Particularly, patients with chronic diseases need constant medical and pharmacological treatment. Therefore, we evaluated a large cohort of patients with adult congenital heart disease (ACHD) regarding postponed medical appointments and their possibilities to receive medical treatment during the COVID-19 pandemic. METHODS This cross-sectional study included 559 patients with ACHD (mean age 37.32 ± 11.98; 47% female). Clinical characteristics, answers to questionnaires concerning lifestyle, psychological well-being, addictive behavior and adherence were related to postponed medical appointments and limited access to medical care. RESULTS One hundred and nine patients (19.5%) reported problems getting necessary medical treatment or visiting a physician. Higher anxiety levels (p = 0.004) emerged as the main factor associated with medical undertreatment. The main risk factors for postponement of least one medical appointment (n = 91) were higher depression (p = 0.013) and anxiety (p = 0.05) symptoms as well as female sex (p ≤ 0.0001) and documented arrhythmias (p = 0.007) indicating a particular risk group of cardiovascular complications. In contrast, frequent physical activity identified patients at lower risk. CONCLUSION In ACHD anxiety and depressive symptoms handicap patients to receive medical care. Postponement of medical appointments additionally relates to female sex and documented arrhythmias. The latter indicates that patients at high risk of adverse cardiac outcome avoid routine medical care. Our data may lead policy makers to develop strategies for the provision of medical services to particular vulnerable patient groups, and to optimize management of both future pandemics and daily routine.
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Affiliation(s)
- Steffen Akkermann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tim Halling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Ann S Silber-Peest
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tillmann Krüger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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21
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Brodie KD, Fakurnejad S, Czechowicz JA, Nadaraja GS. Associations between demographic factors and pediatric otolaryngology access disparities in the COVID-19 era. Int J Pediatr Otorhinolaryngol 2022; 152:110971. [PMID: 34782175 PMCID: PMC9754654 DOI: 10.1016/j.ijporl.2021.110971] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the impact of demographic factors and telehealth on access to pediatric otolaryngology care during the COVID-19 pandemic, as measured by attendance. METHODS Retrospective, observational study of all referrals to pediatric otolaryngology at a single, tertiary care pediatric hospital system in the US. All referrals placed to pediatric otolaryngology from March through December 2020 were compared with referrals between March and December 2019. Data on patient demographics, date of referral, duration between referral and appointment, appointment type, and diagnosis acuity were collected. A multivariate linear regression was used to evaluate the impact of the patient age, ethnicity, language, insurance, diagnosis acuity, time to appointment, and appointment type on attendance. RESULTS This study included 1988 referrals placed between March 16th-December 31st, 2020 and 3704 referrals placed between March 16th-December 31st, 2019. In 2020, attendance proportions were significantly higher at 72% compared to 62% during 2019 (p < 0.001). In 2020, there was a significantly shorter duration between referral and appointment, averaging 10 days as compared to 26 days in 2019 (p < 0.001). Overall, Black and Hispanic patients, children over the age of one, publicly insured patients, and those with longer wait times were less likely to attend their appointments. Primary language and use of telehealth did not predict attendance. CONCLUSION Early evidence has found significant healthcare access and outcome disparities across ethnicities during the COVID pandemic. However, there is limited data evaluating the effect of demographic factors or telehealth on access to pediatric otolaryngology care. This study identifies age, race and insurance type as predictors of access to pediatric otolaryngologic care, as measured by attendance.
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Affiliation(s)
| | - Shayan Fakurnejad
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, USA.
| | | | - Garani S. Nadaraja
- Corresponding author. 2233 Post Street, 3rd Floor, Box 1225, San Francisco, CA, USA
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22
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Abstract
BACKGROUND To promote good health in patients with congenital heart disease (CHD), prevention of gaps in care is essential, as adverse prognosis is associated with care gaps. A well-organised, formal transition programme may help prevent loss to follow up after leaving paediatric care. To inform the development of a transition programme, we investigated factors associated with care gaps in adults with CHD. METHODS Between 15 October 2018 and 15 November 2019 data on patient characteristics and patient experiences with transition-related education, difficulties, and gaps in care were collected and assessed in 87 adults with CHD. Two groups (with gaps in care versus without gaps) were compared to identify informative differences using chi-squared, Fisher's exact tests, or Wilcoxon rank-sum tests. To assess the relationship between care gaps and identified variables, factors with significant difference (p < 0.05) in bivariate analyses were employed as covariates in multivariable logistic regression analysis. RESULTS About half of the study cohort reported having gaps in care. In a multivariate model, patients having thorough discussion about the importance of receiving adult care in paediatric care were 70% less likely to experience gaps (odds ratio 0.303, 95% CI 0.14, 0.66). Forty-seven percent of patient-perceived barriers to transitioning originated from negative feelings associated with transfer. CONCLUSION Gaps in care are highly prevalent in adults with CHD. For a transition programme to be most effective, curriculum development may need to consider the differential impact of various factors and target areas to mitigate the psychological stress associated with transfer.
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23
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de la Rosa AL, Singer-Englar T, Tompkins RO, Patel JK, Kobashigawa JA, Kittleson MM. Advanced heart failure and heart transplantation in adult congenital heart disease in the current era. Clin Transplant 2021; 35:e14451. [PMID: 34365682 DOI: 10.1111/ctr.14451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/24/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) may undergo heart transplantation (HTx) despite increased risk of poor short-term outcomes due to factors including surgical complexity and antibody sensitization. We assessed the clinical characteristics and outcomes of patients with ACHD in the current era referred for HTx at a single high-volume transplant center. METHODS From 2010-2020, 37 ACHD patients were evaluated for HTx. ACHD HTx recipients were compared to non-ACHD HTx recipients matched for age, sex, listing status, and prior cardiac surgery. RESULTS Of the 37 patients with ACHD, 8 (21.6%) were declined for HTx. Of 29 ACHD patients listed, 19 (65.5%) underwent HTx. Compared with non-ACHD HTx controls, the ACHD HTx recipients had more treated cellular (21.1% vs 15.8%, p = 0.010) and antibody-mediated (15.8% vs 10.5%, p = 0.033) rejection. There was no difference in hospital readmission or allograft vasculopathy at 1 year. There was a nonsignificant higher 1-year mortality in ACHD HTx recipients (21.1% vs 7.9%, p = 0.21). CONCLUSION At a high-volume transplant center, ACHD patients undergoing HTx appear to have a marginally higher risk of rejection, but no significant increase in 1-year mortality. With careful selection and management, HTx for patients with ACHD may be feasible in the current era. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Angelo L de la Rosa
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tahli Singer-Englar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rose O Tompkins
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jignesh K Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jon A Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Lammers AE, Helm PC, Bauer UM, van Huelsen AK, Schneider H, Baumgartner H, Diller GP. Optimizing Care for Adults with Congenital Heart Disease: Results of a Conjoint Analysis Based on a Nationwide Sample of Patients Included in the German National Register. J Clin Med 2021; 10:jcm10163483. [PMID: 34441779 PMCID: PMC8396998 DOI: 10.3390/jcm10163483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Congenital heart disease (CHD) requires lifelong specialized care. Failure to follow up and gaps in care are common in this group and lead to increased morbidity/mortality. We evaluated patients’ perceived needs and expectations regarding specialized care using state-of-the-art statistical and market research techniques based on a nationwide sample of CHD patients. (2) Methods: A random sample of adults with CHD registered in the German National Register for Congenital Heart Defects were invited to answer an adaptive online questionnaire based on the conjoint analysis (CA) technique. CA determines the relative importance of various aspects of health care provision and allows individuals to trade between characteristics, thus recognizing limited resources. (3) Results: 637 patients participated (mean age 33.8 ± 12.6 years; 55.6% female; disease complexity: simple defect 12.6%, moderate complexity 40.3%, complex CHD 40.2%) in the analysis. Patients assigned the highest relative importance to aspects of patient–physician communication, physician qualifications, waiting time, medical care, and medical equipment. Comfort-related aspects such as driving time or hotel aspects of care received much lower scores. We identified four well-defined clusters of patients with differing expectation patterns: (i) time sensitive patients; (ii) excellence seeking patients; (iii) continuity seekers, and (iv) support seeking patients. (4) Conclusions: Adult CHD patients rank effective patient–physician interaction and communication as the most important factors. As we identified significant heterogeneity between CHD patients, centers should cater for individual preferences and integrate individual needs into treatment plans to prevent failure to follow up and ensure patient compliance.
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Affiliation(s)
- Astrid E. Lammers
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Münster, Germany;
- Department of Paediatric Cardiology, University Hospital Münster, 48149 Münster, Germany
- Correspondence: (A.E.L.); (G.-P.D.); Tel.: +49-251-8346110 (A.E.L. & G.-P.D.)
| | - Paul C. Helm
- National Register for Congenital Heart Defects, Augustenburger Platz 1, 13353 Berlin, Germany; (P.C.H.); (U.M.B.)
| | - Ulrike M. Bauer
- National Register for Congenital Heart Defects, Augustenburger Platz 1, 13353 Berlin, Germany; (P.C.H.); (U.M.B.)
- DZHK (German Centre for Cardiovascular Research), Potsdamer Straße 58, 10785 Berlin, Germany
| | | | - Helmut Schneider
- Department of Marketing, Steinbeis-Hochschule, Ernst-Augustin-Straße 15, 12489 Berlin, Germany;
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Münster, Germany;
| | - Gerhard-Paul Diller
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Münster, Germany;
- National Register for Congenital Heart Defects, Augustenburger Platz 1, 13353 Berlin, Germany; (P.C.H.); (U.M.B.)
- Correspondence: (A.E.L.); (G.-P.D.); Tel.: +49-251-8346110 (A.E.L. & G.-P.D.)
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Arvanitaki A, Yacoub M, Gatzoulis MA, Kempny A. Arterial switch operation for transposition of the great arteries: Excellent long-term outcome providing close tertiary follow-up. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Willems R, Ombelet F, Goossens E, De Groote K, Budts W, Moniotte S, de Hosson M, Van Bulck L, Marelli A, Moons P, De Backer J, Annemans L. Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:951-960. [PMID: 33835328 DOI: 10.1007/s10198-021-01300-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
AIM To scrutinize the economic impact of different care levels, such as shared care, in the follow-up of adult congenital heart disease (ACHD) patients. METHODS The BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC) was analyzed. Patients (N = 6579) were categorized into five care levels based on their cardiac follow-up pattern between 2006 and 2010. Medical costs, hospitalizations, and emergency department visits were measured between 2011 and 2015. RESULTS In patients with moderate lesions, highly specialized cardiac care (HSC; exclusive follow-up by ACHD specialists) and shared care with predominantly specialized cardiac care (SC+) were associated with significantly lower medical costs and resource use compared to shared care with predominantly general cardiac care (SC-) and general cardiac care (GCC). In the patient population with mild lesions, HSC was associated with better economic outcomes than SC- and GCC, but SC+ was not. HSC was associated with fewer hospitalizations (- 33%) and less pharmaceutical costs (- 46.3%) compared to SC+. Patients with mild and moderate lesions in the no cardiac care (NCC) group had better economic outcomes than those in the GCC and SC- groups, but post-hoc analysis revealed that they had a different patient profile than patients under cardiac care. CONCLUSION More specialized care levels are associated with better economic outcomes in patients with mild or moderate lesions in cardiac follow-up. Shared care with strong involvement of ACHD specialists might be a management option to consider. Characteristics of patients without cardiac follow-up but good medium-term economic prospects should be further scrutinized.
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Affiliation(s)
- Ruben Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42, Floor 4, 9000, Ghent, Belgium.
| | - Fouke Ombelet
- KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium
- Division of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Werner Budts
- KU Leuven Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stéphane Moniotte
- Pediatric and Congenital Cardiology Division, St-Luc University Hospital, Brussels, Belgium
| | - Michèle de Hosson
- Department of Adult Congenital Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, QC, Canada
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium
- University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Julie De Backer
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Adult Congenital Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42, Floor 4, 9000, Ghent, Belgium
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Lee MG, Yao JV, Binny S, Larobina M, Skillington P, Grigg LE, Zentner D. Long-term outcome of adult survivors of tetralogy of Fallot. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Khan AD, Valente AM. Don't be alarmed: the need for enhanced partnerships between medical communities to improve outcomes for adults living with congenital heart disease. Eur Heart J 2021; 42:4249-4251. [PMID: 34079994 DOI: 10.1093/eurheartj/ehab281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Abigail D Khan
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Anne Marie Valente
- Boston Adult Congenital Heart Disease Program, Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Goossens E, van Deyk K, Budts W, Moons P. Are missed appointments in an outpatient clinic for adults with congenital heart disease the harbinger for care gaps? Eur J Cardiovasc Nurs 2021; 21:127-134. [PMID: 34235534 DOI: 10.1093/eurjcn/zvab012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/26/2021] [Accepted: 02/11/2021] [Indexed: 01/10/2023]
Abstract
AIMS Life-long follow-up is vital for patients with congenital heart disease (CHD) to safeguard longevity. Missing scheduled appointments might be prodromal to subsequent care gaps, but our understanding of their occurrence and impact is limited. This study determined the occurrence and predictors of missed appointments (MA), assess its predictive value for care gaps, and explored if MA or care gaps are associated with increased mortality. METHODS AND RESULTS From 2007 to 2009, the occurrence of MA in 2075 CHD patients was documented at an adult CHD clinic. The frequency of outpatient visits in 1363 adults with moderate to complex CHD was calculated from 2009 to 2012. Patients without a visit were considered to have a care gap. Data on mortality were collected from 2013 to 2017. Missed appointments occurred in 11% of patients and were more common in men [odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18-2.08], without a history of cardiac procedures (OR = 1.46; 95% CI: 1.08-1.97), and for morning visits (OR = 1.45; 95% CI: 1.10-1.92). Care gaps were identified in 6% of moderate to complex CHD. A MA was significantly associated with an increased likelihood of care gaps (OR = 19.55; 95% CI: 11.92-32.07; R2 = 26.5%). In moderate to complex CHD, no difference in mortality rates was related to the occurrence of discontinued care. CONCLUSION The occurrence of MA was related to patients' gender, no history of cardiac interventions, and time of day of the outpatient visits. Care gaps were associated by the preceding MA. No association with increased mortality rates was observed. Interventions reducing missed appointments, such as SMS-reminders prior to visits, need investigation.
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Affiliation(s)
- Eva Goossens
- Faculty of Medicine and Health Sciences, Division of Nursing and Midwifery, Centre for Research and Innovation in Care, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.,KU Leuven Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium.,Department of Patient Care, Antwerp University Hospital, Antwerp, Belgium
| | - Kristien van Deyk
- Department of Cardiovascular Sciences, Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, KU, Belgium
| | - Werner Budts
- Department of Cardiovascular Sciences, Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, KU, Belgium
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease. J Clin Med 2021; 10:jcm10081554. [PMID: 33917168 PMCID: PMC8067842 DOI: 10.3390/jcm10081554] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023] Open
Abstract
In adult congenital heart disease (ACHD), major depressive disorder (MDD) represents a frequent comorbidity. In non-CHD, adverse outcome is predicted by MDD and heart rate variability (HRV), whereas in ACHD their prognostic relevance is unknown. We prospectively evaluated 171 patients (age 35.6 ± 11.4 years; male 42.7%, mean observation time 54.7 ± 14.9 months). Binary regression analysis calculated the association between MDD and HRV. Cox proportional survival analysis estimated their impact on decompensated heart failure and all-cause mortality (HF/death), supraventricular and ventricular tachycardia (SVT/VT), and hospitalization due to unexpected cardiac causes. Exclusively MDD with moderate/severe symptoms showed significantly lower HRV as derived from frequency-domain analysis (Symindex) (p = 0.013). In multivariate Cox regression analysis, patients stratified according to the lower quartile of the Symindex comorbid with MDD (n = 16) exhibited poorer prognosis regarding HF/death (Hazard Ratio (HR): 7.04 (95%CI:(1.87–26.5)), SVT/VT (HR: 4.90 (95%CI:1.74–9.25)) and hospitalization (HR: 3.80 (95%CI:1.36–10.6)). An additional independent predictor was N-terminal pro-B-type natriuretic peptide elevation (p < 0.001), indicating advanced HF and heart disease complexity (p < 0.001). Autonomic nervous system dysfunction measured by altered HRV is considered to be one of the pathways linking MDD and adverse outcomes in cardiac diseases. Our results exceed the existing literature by demonstrating that MDD with decreased HRV is associated with poorer prognosis in ACHD.
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3176] [Impact Index Per Article: 1058.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Halling T, Akkermann S, Löffler F, Groh A, Heitland I, Haefeli WE, Bauersachs J, Kahl KG, Westhoff-Bleck M. Factors That Influence Adherence to Medication in Adults With Congenital Heart Disease (ACHD). Front Psychiatry 2021; 12:788013. [PMID: 34899440 PMCID: PMC8660073 DOI: 10.3389/fpsyt.2021.788013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Innovative operative and interventional procedures have improved survival in congenital heart disease (CHD), and today more than 90% of these children reach adulthood. Consequently, adherence and psychosocial issues are becoming increasingly important because non-adherence to treatment recommendations worsens morbidity and mortality. This study aimed to identify factors modifying adherence to medication in adult congenital heart disease (ACHD). Methods: This cross-sectional study included 451 outpatients (female 47.9%, average age ± SD: 37.9 ± 12 years) from the ACHD department, who completed a questionnaire assessing medication non-adherence and individual barriers to treatment. Further assessments included psychological well-being (Hospital Anxiety and Depression scale; HADS), childhood traumatization, sociodemographic, and clinical data. Binary logistic regression analysis calculated the impact of these factors on drug adherence. Results: Of the 451 patients 162 participants (35.9%) reported to be non-adherent. In univariate analysis non-adherence to treatment was associated with smoking (P = < 0.001) and internet addiction (P = 0.005). Further factors negatively influencing adherence were the presence of depressive symptoms (P = 0.002), anxiety (P = 0.004), and childhood traumatization (p = 0.002). Factors positively associated with adherence were older age (P = 0.003) and more advanced heart disease as indicated by NYHA class (P = 0.01), elevated NT-proBNP (P = 0.02), device therapy (P = 0.002) and intermittent arrhythmias (P = 0.01). In multivariate analysis especially psychopathological factors such as depression (P = 0.009), anxiety (P = 0.032) and childhood traumatization (P = 0.006) predicted non-adherence. Conclusion: Adherence is a critical issue in the long-term management of ACHD. Identifying modifiable factors that worsen adherence offers the opportunity for targeted interventions. Depressive symptoms, anxiety, and adverse childhood experiences are amenable to psychosocial interventions, as well as cigarette smoking. Our study suggests that a multimodal and interdisciplinary treatment concept for the long-term management of adults with congenital heart disease could be beneficial. Whether it will further improve morbidity and mortality, should be assessed in prospective interventions.
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Affiliation(s)
- Tim Halling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Steffen Akkermann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Ivo Heitland
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Dimopoulos K, Opotowsky AR, Constantine A, D'Alto M. Often transferred, rarely transitioned: The current state of transition for young people with congenital heart disease. Int J Cardiol 2020; 329:89-90. [PMID: 33387556 DOI: 10.1016/j.ijcard.2020.12.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- K Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - A R Opotowsky
- Cincinnati Adult Congenital Heart Program, Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - A Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - M D'Alto
- Department of Cardiology, University "L. Vanvitelli" - Monaldi Hospital, Naples, Italy
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Constantine A, Tulloh RMR, Turquet R, Dimopoulos K, Moledina S. PAH-CHD: transition to adulthood. JOURNAL OF CONGENITAL CARDIOLOGY 2020. [DOI: 10.1186/s40949-020-00043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A structured transition provides a framework of care that bridges the gap between paediatric and adult medicine. It is essential for achieving continuity of care and providing support and education around the challenging period of adolescence for young people with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD).
Presentation
In this review of transition care in PAH-CHD, we evaluate the evidence supporting a structured programme of transition care and review the current principles and ‘best practice’ standards for transition in the UK. In the second part of the review, we highlight some important areas of education that are relevant to adolescents with PAH-CHD, including health education, exercise and participation in sports, pregnancy and contraception, employment, and driving.
Conclusions
As the number of young people embarking on transition continues to increase, the challenge is set to continue to improve the quality of care for our patients within the framework of available resources.
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Kim Y, Ahn E, Lee S, Lim DH, Kim A, Lee SG, So MW. Changing Patterns of Medical Visits and Factors Associated with No-show in Patients with Rheumatoid Arthritis during COVID-19 Pandemic. J Korean Med Sci 2020; 35:e423. [PMID: 33316859 PMCID: PMC7735912 DOI: 10.3346/jkms.2020.35.e423] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The main barrier to the effective rheumatoid arthritis (RA) therapy is poor adherence. Coronavirus disease 2019 (COVID-19) pandemic have led to a significant change in the pattern and the number of medical visits. We assessed changing patterns of medical visits and no-show, and identified factors associated with no-show in patients with RA during COVID-19 pandemic. METHODS RA patients treated with disease-modifying antirheumatic drugs at least 6 months who had been in remission or those with mild disease activity were observed for 6 months from February to July 2020. No-show was defined as a missed appointment that was not previously cancelled by the patient and several variables that might affect no-show were examined. RESULTS A total of 376 patients and 1,189 appointments were evaluated. Among 376 patients, 164 patients (43.6%) missed appointment more than one time and no-show rate was 17.2% during COVID-19 pandemic. During the observation, face-to-face visits gradually increased and no-show gradually decreased. The logistic regression analysis identified previous history of no-show (adjusted odds ratio [OR], 2.225; 95% confidence interval [CI], 1.422-3.479; P < 0.001) and fewer numbers of comorbidities (adjusted OR, 0.749; 95% CI, 0.584-0.961; P = 0.023) as the independent factors associated with no-show. CONCLUSION Monthly analysis showed that the no-show rate and the pattern of medical visits gradually changed in patients with RA during COVID-19 pandemic. Moreover, we found that previous history of no-show and fewer numbers of comorbidities as the independent factors associated with no-show.
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Affiliation(s)
- Yena Kim
- Department of Nursing, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Eunyoung Ahn
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sunggun Lee
- Division of Rheumatology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Doo Ho Lim
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Aran Kim
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seung Geun Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Min Wook So
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
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Brida M, Šimkova I, Jovović L, Prokšelj K, Antonová P, Balint HO, Gumbiene L, Lebid IH, Komar M, Kratunkov P, Kovačević Preradović T, Ermel R, Strenge A, Coman IM, Vukomanović V, Gatzoulis MA, Roos-Hesselink JW, Diller GP. European Society of Cardiology Working Group on Adult Congenital Heart Disease and Study Group for Adult Congenital Heart Care in Central and South Eastern European Countries consensus paper: current status, provision gaps and investment required. Eur J Heart Fail 2020; 23:445-453. [PMID: 33135840 DOI: 10.1002/ejhf.2040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022] Open
Abstract
AIMS To examine the current status of care and needs of adult congenital heart disease (ACHD) services in the Central and South Eastern European (CESEE) region. METHODS AND RESULTS We obtained data regarding the national ACHD status for 19 CESEE countries from their ACHD representative based on an extensive survey for 2017 and/or 2018. Thirteen countries reported at least one tertiary ACHD centre with a median year of centre establishment in 2007 (interquartile range 2002-2013). ACHD centres reported a median of 2114 patients under active follow-up with an annual cardiac catheter and surgical intervention volume of 49 and 40, respectively. The majority (90%) of catheter or surgical interventions were funded by government reimbursement schemes. However, all 19 countries had financial caps on a hospital level, leading to patient waiting lists and restrictions in the number of procedures that can be performed. The median number of ACHD specialists per country was 3. The majority of centres (75%) did not have ACHD specialist nurses. The six countries with no dedicated ACHD centres had lower Gross Domestic Product per capita compared to the remainder (P = 0.005). CONCLUSION The majority of countries in CESEE now have established ACHD services with adequate infrastructure and a patient workload comparable to the rest of Europe, but important gaps still exist. ACHD care is challenged or compromised by limited financial resources, insufficient staffing levels, and reimbursement caps on essential procedures compared to Western Europe. Active advocacy and increased resources are required to address the inequalities of care across the continent.
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Affiliation(s)
- Margarita Brida
- Division for Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Iveta Šimkova
- ACHD Centre, Department of Cardiology and Angiology of Medical Faculty, Slovak Medical University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | | | - Katja Prokšelj
- Adult Congenital Heart Centre, University Medical Center, Ljubljana, Slovenia
| | - Petra Antonová
- Cardiovascular Centre, University Hospital Motol, Prague, Czech Republic
| | - Hajnalka Olga Balint
- Department of Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Lina Gumbiene
- Hatter Institute for Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ihor H Lebid
- Ukrainian Children's Cardiac Center, Kyiv, Ukraine
| | - Monika Komar
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Pencho Kratunkov
- Department of Cardiology, University Hospital St. Ekaterina, Sofia, Bulgaria
| | - Tamara Kovačević Preradović
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Raili Ermel
- Department of Cardiac surgery, Tartu University Hospital, Tartu, Estonia
| | - Agnese Strenge
- Pauls Stradins Clinical University hospital, Latvian Center of Cardiology, Riga, University of Latvia, Riga, Latvia
| | - Ioan Mircea Coman
- University of Medicine and Pharmacy "Carol Davila", Institute of Cardiovascular Diseases "Prof Dr C.C. Iliescu", Bucharest, Romania
| | | | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | | | - Gerhard-Paul Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
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Keir M, Penner M, Dehghani P, Neudorf C, Lim HJ, Bradley TJ, Bree T, Kakadekar A. Barriers to Care in ACHD: A Study of Young Adults in Saskatchewan. CJC Open 2020; 2:439-446. [PMID: 33305202 PMCID: PMC7710945 DOI: 10.1016/j.cjco.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/23/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Adults with congenital heart disease (CHD) are living longer with more complex disease. Maintaining lifelong care prevents morbidity and mortality, but many patients remain lost to follow-up or experience care gaps. We sought to assess barriers to care for patients with adult CHD (ACHD) in Saskatchewan, a Canadian province with no local congenital cardiac surgical support and no clear framework for ACHD care. METHODS We performed a telephone survey of patients with CHD transferred from pediatric to adult cardiology from 2007 to 2014. Our primary outcome was loss to follow-up > 2 years from last recommended cardiology appointment and/or multiple missed cardiology appointments. Secondary outcomes were guideline-based care (specialist training, adherence to appropriate endocarditis prophylaxis, pre-pregnancy counselling for women), presence or absence of previously described barriers to care in ACHD, and health care autonomy using the Krantz Health Opinion Survey. RESULTS We interviewed 32 patients (30% response rate). One-quarter met the primary outcome: lost to follow-up > 2 years from last recommended cardiology appointment and/or self-report of missed cardiology appointments. Only 69% of young adults in Saskatchewan were receiving guideline-based care for their CHD (appropriate level of specialist expertise and frequency of follow-up). Only 72% of patients were adhering to endocarditis prophylaxis recommendations and 61% of women surveyed received counselling regarding pregnancy. Patients indicated a low preference for participating in decision making regarding their care on the Krantz Health Opinion Survey. CONCLUSIONS With our survey, we have created a novel snapshot of CHD care in Saskatchewan and have identified significant deficits.
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Affiliation(s)
- Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Marie Penner
- Division of Pediatric Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hyun J. Lim
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Timothy J. Bradley
- Division of Pediatric Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Terry Bree
- Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ashok Kakadekar
- Division of Pediatric Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Su W, Zhu C, Zhang X, Xie J, Gong Q. <p>Who Misses Appointments Made Online? Retrospective Analysis of the Outpatient Department of a General Hospital in Jinan, Shandong Province, China</p>. Healthc Policy 2020; 13:2773-2781. [PMID: 33273875 PMCID: PMC7708679 DOI: 10.2147/rmhp.s280656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Missed appointments in outpatient registration pose challenges for hospital administrators, especially in the context of China’s shortage of medical resources. Previous studies have identified factors that affect healthcare access via traditional appointment systems. Few studies, however, have specifically investigated Internet appointment systems. Therefore, this study explored the key factors related to missed appointments made on the Internet appointment system of a general hospital in Jinan, Shandong Province. Methods Online appointment data were collected from the outpatient department of a general hospital in Jinan from September 2017 to February 2018. Logistic regression was used to analyze the relative importance of eight variables: gender, age, interval between scheduling and appointment, day of the week, physician’s academic rank, appointment fee, previous missed appointments, and clinical department. Results A total of 48,777 online appointment records were collected, which included a 15% no-show rate. The key factors associated with no-shows included age, interval between scheduling and appointment, previous missed appointments, and clinical department. No significant relationships were found between no-shows and gender, day of the week, and appointment fee. Conclusion No-show rates were influenced by many factors. Based on this study’s findings, targeted measures can be taken to decrease no-show frequency and improve medical efficiency.
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Affiliation(s)
- Wei Su
- School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan, Shandong, People’s Republic of China
- Correspondence: Wei Su; Xin Zhang Email ;
| | - Cuiling Zhu
- School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan, Shandong, People’s Republic of China
| | - Xin Zhang
- School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan, Shandong, People’s Republic of China
| | - Jun Xie
- Shunneng Network Technology Limited Company, Jinan, Shandong, People’s Republic of China
| | - Qingxian Gong
- Shunneng Network Technology Limited Company, Jinan, Shandong, People’s Republic of China
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Lachtrupp CL, Valente AM, Gurvitz M, Landzberg MJ, Brainard SB, Opotowsky AR. Interobserver agreement of the anatomic and physiological classification system for adult congenital heart disease. Am Heart J 2020; 229:92-99. [PMID: 32947058 DOI: 10.1016/j.ahj.2020.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023]
Abstract
The Anatomic and Physiological (AP) classification system proposed in the 2018 American College of Cardiology/American Heart Association adult congenital heart disease (ACHD) guidelines assigns 2 dimensions to each patient: anatomic class (AnatC) and physiological stage (PhyS). This approach has not been tested in practice; we assessed interrater reliability and identified sources of disagreement. METHODS Consensus definitions for AP categories were developed with input from 4 experts. Research assistants (RAs) assigned AnatC/PhyS for patients in the Boston ACHD Biobank, a prospectively enrolled cohort of ambulatory ACHD patients ≥18 years old seen between 2012 and 2019. Two (of 4) expert reviewers then independently assigned AnatC/PhyS for 41 patients. Interrater reliability was assessed with linearly weighted kappa (κω) for agreement between (1) experts and (2) an RA and an expert. Experts examined disagreements and identified sources of variability and areas requiring clarification. RESULTS Interexpert agreement for AnatC was excellent, with agreement on 38/41 (92.7%) cases and κω 0.88 [0.75, 1.01]. Agreement for PhyS was less robust, with consensus on 24/41 cases (59.5%), κω 0.57 [0.39, 0.75]. Expert-RA agreement was lower for AnatC (κω 0.77 [0.60, 0.95]), whereas PhyS was similar to interexpert agreement (κω 0.53 [0.34, 0.72]). There was ambiguity in the definitions of (1) arrhythmia status, (2) cyanotic CHD, and (3) valve disease. CONCLUSIONS Although AnatC can be assessed reliably, that is not true for the PhyS part of the AP classification proposed in the 2018 American College of Cardiology/American Heart Association guidelines. Reliability of PhyS would be strengthened by more precise definitions readily interpretable in clinical practice.
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Affiliation(s)
- Cara L Lachtrupp
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael J Landzberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sarah B Brainard
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Alexander R Opotowsky
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA; The Heart Institute, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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Artificial Intelligence Predictive Analytics in the Management of Outpatient MRI Appointment No-Shows. AJR Am J Roentgenol 2020; 215:1155-1162. [DOI: 10.2214/ajr.19.22594] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Srinivas S, Salah H. Consultation length and no-show prediction for improving appointment scheduling efficiency at a cardiology clinic: A data analytics approach. Int J Med Inform 2020; 145:104290. [PMID: 33099184 DOI: 10.1016/j.ijmedinf.2020.104290] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/29/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The observed consultation length at specialty clinics, such as cardiology care, is represented by two underlying groups - one with zero service time due to patient no-shows, and the other characterized by positive values with high variance. This inconstancy affects the scheduler's ability to accurately estimate consultation length, which, in turn, hinders effective utilization of the clinic's resources and timely access to care. The objectives of this study were to: (i) predict the consultation length by accounting for its semicontinuous nature (i.e., zero in case of no-shows and positive otherwise), using machine learning (ML) algorithms, (ii) identify important features for predicting no-shows and non-zero consultation length, and (iii) assess the impact of integrating the ML-based prediction with the appointment scheduling system. METHODS We used two-years of data extracted from the electronic medical records of a cardiology clinic. By leveraging 16 predictors pertaining to the patient, appointment, and doctor, a two-part ML-based approach was developed to handle the semicontinuous consultation length. Supervised classification models were employed to predict no-shows (i.e., categorize the consultation length as zero or positive), and regression algorithms were developed for estimating non-zero consultation lengths. Three algorithms, namely, random forests, stochastic gradient boosting, and deep neural networks, were individually employed for both no-show classification and positive consultation length prediction. Finally, the best performing classification and regression models were combined to establish the complete two-part model, and its prediction error on new data is benchmarked against the clinic's current performance. The evaluation metrics for classification models were area under the receiver operating characteristic curve (AUC-ROC) and area under the precision-recall curve (AUC-PR). The prediction performance of regression algorithms was evaluated by mean absolute error (MAE), root mean squared error (RMSE), and mean absolute percentage error (MAPE). A simulation modeling approach was adopted to ascertain the effectiveness of using ML-based prediction for scheduling decisions as opposed to the clinic's current strategy. RESULTS Among the classification models tested, stochastic gradient boosted classification tree (SGBCT) demonstrated best performance (AUC-ROC = 0.85, AUC-PR = 0.64). For positive consultation length prediction, deep neural network regressor (DNNR) resulted in lowest prediction error (MAE = 8.55, RMSE = 6.88, MAPE = 12.24). The complete two-part model (SGBCT + DNNR) outperformed the clinic's approach to consultation length estimation by achieving 50 % and 52 % reduction in RMSE and MAE, respectively. Further adopting it for appointment scheduling could reduce the patient waiting time and doctor idle time by 56 % and 52 %, respectively. Besides, several clinical insights, along with critical features for no-show and consultation length prediction, were also identified from our proof-of-concept study. CONCLUSION This study demonstrates that routine clinical tasks such as estimation of consultation length and no-shows can be accurately predicted using ML algorithms, and subsequently integrated into the clinical scheduling system to improve resource utilization and reduce patient waiting time.
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Affiliation(s)
- Sharan Srinivas
- Department of Industrial and Manufacturing Systems Engineering, College of Engineering, University of Missouri, Columbia, MO 65211 USA; Department of Marketing, Trulaske College of Business, University of Missouri, Columbia, MO, 65211, USA; Institute for Data Science and Informatics, University of Missouri, Columbia, MO, 65211, USA.
| | - Haya Salah
- Department of Industrial and Manufacturing Systems Engineering, College of Engineering, University of Missouri, Columbia, MO 65211 USA.
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Gatzoulis MA, Chung N, Ferrero P, Chessa M, Giannakoulas G, Tzifa A, Diller GP, Brida M, Al-Sakini N. Adult congenital heart care in the COVID-19 era, and beyond: A call for action. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2020; 1:100002. [PMID: 38620889 PMCID: PMC7429202 DOI: 10.1016/j.ijcchd.2020.100002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
While virus epidemics are nothing new to man, the scale, speed of global spread and immediacy of the COVID-19 pandemic have been truly unprecedented [1]. The entire world has been turned on its head in less than a few months, with major implications beyond disease burden and loss of life, threatening the economic status quo and human psychosocial balance and wellbeing not only for patients, but for all of us. The primary aim of our Call for Action Viewpoint was to support and protect our adult congenital heart disease (ACHD) patients and their needs during these challenging and uncertain times. This goal had to be met while we, as individuals, teams, institutions and nations, came together in a global effort to combat this aggressive virus, that appears to spare no organs or systems, nor any borders, geographic or other. As with any crisis, there is always opportunity: we are submitting herewith a vision for a different and better model of ACHD care, and for a better life journey and health care experience for our patients, that should be in place in the aftermath of the Covid-19 pandemic. Many of the points and principles discussed in this article, need not be confined to ACHD patients, but have a broader reach. And we must not forget nor neglect the most vulnerable in society at this time, namely the elderly, disabled and other dependent or disadvantaged groups in this "We Are One" global operation. Last but not least, this maybe the time to take better care of ourselves (and others) and reflect on life.
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Affiliation(s)
- Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Arterial Hypertension, Royal Brompton & Harefield NHS Trust, National Heart & Lung Institute, Imperial College, London, UK
- Aristotle University Medical School, Thessaloniki, Greece
- Adult Congenital Heart Disease, Guy's and St Thomas' NHS Trust, London, UK
| | - Natali Chung
- Adult Congenital Heart Centre and National Centre for Pulmonary Arterial Hypertension, Royal Brompton & Harefield NHS Trust, National Heart & Lung Institute, Imperial College, London, UK
- Adult Congenital Heart Disease, Guy's and St Thomas' NHS Trust, London, UK
| | - Paolo Ferrero
- Paediatric Cardiology and Adult Congenital Heart Disease, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Massimo Chessa
- ACHD UNIT - Paediatric and Adult Congenital Heart Centre, IRCCS-Policlinico, San Donato, Milan, Italy
| | - George Giannakoulas
- Aristotle University Medical School, Thessaloniki, Greece
- AHEPA Hospital, ESY (Greek National Health System), Thessaloniki, Greece
| | - Aphrodite Tzifa
- Department of Paediatric and Adult Congenital Cardiology, Mitera Hospital, Athens, Greece
- Department of Imaging Sciences, King's College, London, UK
| | - Gerhard P Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Arterial Hypertension, Royal Brompton & Harefield NHS Trust, National Heart & Lung Institute, Imperial College, London, UK
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
| | - Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Arterial Hypertension, Royal Brompton & Harefield NHS Trust, National Heart & Lung Institute, Imperial College, London, UK
- Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia
| | - Nada Al-Sakini
- Adult Congenital Heart Centre and National Centre for Pulmonary Arterial Hypertension, Royal Brompton & Harefield NHS Trust, National Heart & Lung Institute, Imperial College, London, UK
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Gatzoulis MA, Baumgartner H, Camici PF. Welcome to “The new Journal, your Journal the International Journal of Cardiology-Congenital Heart Disease” for the most common and global inborn defect. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2020. [DOI: 10.1016/j.ijcchd.2020.100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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How is the risk of being diagnosed with referable diabetic retinopathy affected by failure to attend diabetes eye screening appointments? Eye (Lond) 2020; 35:477-483. [PMID: 32317793 DOI: 10.1038/s41433-020-0877-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/AIMS This study examines the anecdotal impression that in diabetes eye screening there is a relationship between number of consecutive missed screening appointments and the incidence of referable retinopathy at the next screening appointment that is attended. METHODS A retrospective observational audit was conducted of data from 62,067 people who were due for annual diabetes eye screening in the North East London Diabetes Eye Screening Programme between January 2010 and January 2017, and who had missed at least one screening appointment within that time. RESULTS Missing 5 consecutive screening appointments increased the incidence of referable retinopathy from a programme average of 4% up to 15%. The incidence of referable retinopathy in people missing 10 or more consecutive appointments was ~20%. There was an association between younger age, male gender, type I disease, and being of African ethnicity with increasing number of missed appointments. CONCLUSIONS There was a strong association between the number of missed appointments and the proportion of patients showing referable retinopathy at the next visit. Approaches to reduce the number of missed appointments may help to reduce the incidence of referable retinopathy. These may be targeted at those showing the greatest non-attendance behaviour in the current study.
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4937] [Impact Index Per Article: 1234.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Dantas LF, Hamacher S, Cyrino Oliveira FL, Barbosa SDJ, Viegas F. Predicting Patient No-show Behavior: a Study in a Bariatric Clinic. Obes Surg 2020; 29:40-47. [PMID: 30209668 DOI: 10.1007/s11695-018-3480-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE No-shows of patients to their scheduled appointments have a significant impact on healthcare systems, including lower clinical efficiency and higher costs. The purpose of this study was to investigate the factors associated with patient no-shows in a bariatric surgery clinic. MATERIALS AND METHODS We performed a retrospective study of 13,230 records for 2660 patients in a clinic located in Rio de Janeiro, Brazil, over a 17-month period (January 2015-May 2016). Logistic regression analyses were conducted to explore and model the influence of certain variables on no-show rates. This work also developed a predictive model stratified for each medical specialty. RESULTS The overall proportion of no-shows was 21.9%. According to multiple logistic regression, there is a significant association between the patient no-shows and eight variables examined. This association revealed a pattern in the increase of patient no-shows: appointment in the later hours of the day, appointments not in the summer months, post-surgery appointment, high lead time, higher no-show history, fewer numbers of previous appointments, home address 20 to 50 km away from the clinic, or scheduled for another specialty other than a bariatric surgeon. Age group, forms of payment, gender, and weekday were not significant predictors. Predictive models were developed with an accuracy of 71%. CONCLUSION Understanding the characteristics of patient no-shows allows making improvements in management practice, and the predictive models can be incorporated into the clinic dynamic scheduling system, allowing the use of a new appointment policy that takes into account each patient's no-show probability.
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Affiliation(s)
- Leila F Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Fernando L Cyrino Oliveira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Simone D J Barbosa
- Department of Informatics, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Fábio Viegas
- Institute of Gastro and Obesity Surgery, Rua Paulo Barreto, 73, Rio de Janeiro, RJ, 22280-010, Brazil.
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Adult and Paediatric Cardiac Intervention in Timor-Leste: Disease Burden, Demographics and Clinical Outcomes. Heart Lung Circ 2019; 29:1112-1121. [PMID: 31831263 DOI: 10.1016/j.hlc.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The East Timor Hearts Fund (ETHF) is a charitable organisation of Australian cardiologists providing outreach screening in Timor-Leste. For patients requiring intervention, ETHF arranges logistics, procedures, and postoperative care. The aim of this project is to evaluate outcomes of patients requiring intervention. METHODS The ETHF database of all patients was utilised to identify patients with disease warranting surgical or percutaneous intervention. Both patients who underwent intervention and those who did not proceed to intervention were included in this study. Patients who had intervention arranged by other organisations but have then had follow-up with ETHF were also included. Overall demographics and pre and postoperative factors were assessed, with sub-group analysis of adult and paediatric patients to identify any differences in care. RESULTS Of 221 patients requiring intervention, 101 patients underwent intervention, receiving 22 different operations or procedures. Patients were predominantly young (median age 17.5 years) and female (64.7%), with rheumatic heart disease (63.8%). Twenty-four (24) (33.3%) women aged 15-45 years old with cardiac disease warranting intervention were documented as pregnant or breastfeeding at time of clinic assessment. Of patients who did not proceed to intervention, adults were more likely to be lost to follow-up (42.4% vs 18.5%) while paediatric patients were more likely to experience progression of disease (18.5% vs 7.5%, p=0.005). Median waitlist time was 5 months, with no significant difference between adults and children, correlating with a preoperative mortality rate of 5.4%. For patients who underwent intervention, post-procedure mortality was extremely low (0.9%) and attendance of at least one post-procedure review was excellent (99.0%). Eleven (11) (10.9%) patients have required repeat intervention, with no difference in rates between adult and paediatric patients. Length of follow-up extends up to 20 years for some patients. CONCLUSION The Timor-Leste interventional cohort was predominantly a young female population with rheumatic and congenital cardiac disease. There were also high rates of pregnancy amongst female patients with severe cardiac disease. Delayed access to intervention may result in preoperative adverse events and mortality, and is a key target for improvement. Patients who undergo intervention have very low post-procedural mortality, good adherence to early medical follow-up and good long-term outcomes.
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5401] [Impact Index Per Article: 1080.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cordina R, Nasir Ahmad S, Kotchetkova I, Eveborn G, Pressley L, Ayer J, Chard R, Tanous D, Robinson P, Kilian J, Deanfield JE, Celermajer DS. Management errors in adults with congenital heart disease: prevalence, sources, and consequences. Eur Heart J 2019; 39:982-989. [PMID: 29236965 DOI: 10.1093/eurheartj/ehx685] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/03/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Improved survival has resulted in increasing numbers and complexity of adults with congenital heart disease (ACHD). International guidelines recommend specialized care but many patients are still not managed at dedicated ACHD centres. This study analysed referral sources and appropriateness of management for patients referred to our tertiary ACHD Centre over the past 3 years. Methods and results We compared differences in care between patients referred from paediatric/ACHD-trained vs. general adult cardiologists, according to Adherence (A) or Non-Adherence (NA) with published guidelines. Non-Adherent cases were graded according to the severity of adverse outcome or risk of adverse outcome. Of 309 consecutively referred patients (28 ± 14 years, 51% male), 134 (43%) were from general cardiologists (19% highly complex CHD) and 115 (37%) were from paediatric cardiology or ACHD specialists (33% highly complex CHD). Sixty referrals (20%) were from other medical teams and of those, 31 had been lost to follow-up. Guideline deviations were more common in referrals from general compared to CHD-trained cardiologists (P < 0.001). Of general cardiology referrals, 49 (37%) were NA; 18 had catastrophic or major complications (n = 2, 16 respectively). In contrast, only 12 (10%) of the paediatric/ACHD referrals were NA, but none of these were catastrophic and only 3 were major. Simple, moderate, and highly complex CHD patients were at increased risk of adverse outcome when not under specialized CHD cardiology care (P = 0.04, 0.009, and 0.002, respectively). Conclusion Non-adherence with guidelines was common in the ACHD population, and this frequently resulted in important adverse clinical consequences. These problems were more likely in patients who had not been receiving specialized CHD care. Configuring healthcare systems to optimize 'whole of life' care for this growing population is essential.
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Affiliation(s)
- Rachael Cordina
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Subha Nasir Ahmad
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Irina Kotchetkova
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Gry Eveborn
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Lynne Pressley
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Julian Ayer
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia.,The Heart Centre for Children, The Children's Hospital at Westmead, 170 Hawkesbury Rd, Westmead, NSW 2145, Australia
| | - Richard Chard
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia.,Department of Cardiology and Cardiothoracic Surgery, Westmead Hospital, Westmead, NSW 2145, Australia
| | - David Tanous
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia.,Department of Cardiology and Cardiothoracic Surgery, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Peter Robinson
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Jens Kilian
- Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - John E Deanfield
- Department of Cardiology, Great Ormond Street Hospital, London WC1N 3JH, UK.,The National Centre for Cardiovascular Prevention and Outcomes, University College London, Nomura House, 1 St Martin's le Grand, London EC1A 4NP, UK
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
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Best KE, Vieira R, Glinianaia SV, Rankin J. Socio-economic inequalities in mortality in children with congenital heart disease: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2019; 33:291-309. [PMID: 31347722 DOI: 10.1111/ppe.12564] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/02/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The impact of socio-economic status (SES) on congenital heart disease (CHD)-related mortality in children is not well established. OBJECTIVES We aimed to systematically review and appraise the existing evidence on the association between SES (including poverty, parental education, health insurance, and income) and mortality among children with CHD. DATA SOURCES Seven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, citations, and key journals were searched. STUDY SELECTION AND DATA EXTRACTION We included articles reporting original research on the association between SES and mortality in children with CHD if they were full papers published in the English language and regardless of (a) timing of mortality; (b) individual or area-based measures of SES; (c) CHD subtype; (d) age at ascertainment; (e) study period examined. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate. SYNTHESIS Meta-analyses were performed to estimate pooled ORs for in-hospital mortality according to health insurance status. RESULTS Of 1388 identified articles, 28 met the inclusion criteria. Increased area-based poverty was associated with increased odds/risk of postoperative (n = 1), neonatal (n = 1), post-discharge (n = 1), infant (n = 1), and long-term mortality (n = 2). Higher parental education was associated with decreased odds/risk of neonatal (n = 1) and infant mortality (n = 5), but not with long-term mortality (n = 1). A meta-analysis of four US articles showed increased unadjusted odds of in-hospital mortality in those with government/public versus private health insurance (OR 1.40, 95% CI 1.24, 1.56). The association between area-based income and CHD-related mortality was conflicting, with three of eight articles reporting significant associations. CONCLUSION This systematic review provides evidence that children of lower SES are at increased risk of CHD-related mortality. As these children are over-represented in the CHD population, interventions targeting socio-economic inequalities could have a large impact on improving CHD survival.
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Affiliation(s)
- Kate E Best
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Rute Vieira
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK.,The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
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