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Holzer RJ. IMPACTing the Future: Are we on the Right Track? Pediatr Cardiol 2022; 43:821-826. [PMID: 34988600 DOI: 10.1007/s00246-021-02793-w] [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: 11/13/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022]
Abstract
More than ten years have passed since data collection was initiated in the IMPACT registry. Over the last decade, difficulties in data access and a lack of autonomy have led to a disengagement of the congenital community, with the usefulness of IMPACT to patients and providers being questioned. This article outlines some of problems identified using an online survey among interventional congenital cardiologists, and provides possible solutions for the future.
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Affiliation(s)
- Ralf J Holzer
- David Wallace - Starr Foundation Professor of Pediatric Cardiology, Division Chief of Pediatric Cardiology, Weill Cornell Medicine, Director Pediatric Cardiac Catheterization, NewYork-Presbyterian Komansky Children's Hospital, 525 East 68th Street, Room F-677, New York, NY, 10065, USA.
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The effect of the duration of the procedure on the risk of complications during pediatric cardiac catheterization. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:467-473. [PMID: 32953209 DOI: 10.5606/tgkdc.dergisi.2020.19057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/23/2020] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate the frequency of and associated risk factors for adverse events caused by cardiac catheterization procedures in pediatric patients. Methods Between January 2009 and January 2012, a total of 599 pediatric patients (320 males, 279 females; mean age 5.4±4.7 years; range, 1 day to 21 years) who underwent cardiac catheterization in our cardiac catheterization laboratory were retrospectively analyzed. Demographic and clinical data of the patients including the duration of the procedure, management of anesthesia, the American Society of Anesthesiologists class, and Catheterization Risk Score for Pediatrics, and procedure-related serious adverse events were recorded. Results The incidence of procedure-related serious adverse events was 9.18%. Potential risk factors associated with serious adverse events were identified as interventional heart catheterization, high scores obtained from the Catheterization Risk Score for Pediatrics, the use of endotracheal tube in airway control, and prolonged procedural duration. Conclusion Our study results suggest that prolonged duration of catheterization is a potential risk factor for procedure-related adverse events and the duration of the procedure needs to be included as a variable in the Catheterization Risk Score for Pediatrics scoring system for predicting procedure-related adverse events.
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Holzer RJ, Dayton JD. Registries, Risk Calculators, and Risk-Adjusted Outcomes: Current Usage, Limitations, and Future Prospects. Pediatr Cardiol 2020; 41:443-458. [PMID: 32198591 DOI: 10.1007/s00246-020-02300-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
Small study sizes are a limiting factor in assessing outcome measures in pediatric cardiology. It is even more difficult to assess the outcomes of congenital catheterizations where the sample sizes are even smaller, particularly on a individual institutional level. The creation of multicenter registries is a method by which investigators can pool data to better assess quality and outcome measures of these procedures. No registry is perfect with several being available today, each with its own strengths and weaknesses. In addition, there are a multitude of methods currently used to assess quality and outcomes from the data contained in these registries, each having its own limitations as well. Nonetheless, multicenter registrities remain one of the best available options to improve the quality of care for pediatric interventional cardiac catheterization. Below, we provide an overview of the current state of quality assessment/improvement in pediatric interventional cardiology including a review of the available registrities and the metrics used to measure quality of care and outcomes.
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Affiliation(s)
- Ralf J Holzer
- NewYork-Presbyterian Komansky Children's Hospital, New York, USA.
- Weill Cornell Medicine, New York, USA.
- David Wallace - Starr Foundation, Division of Pediatric Cardiology, Pediatric Cardiac Catheterization, NewYork-Presbyterian Komansky Children's Hospital, New york, USA.
| | - Jeffrey D Dayton
- NewYork-Presbyterian Komansky Children's Hospital, New York, USA
- Weill Cornell Medicine, New York, USA
- Department of Pediatrics, 525 East 68th Street, Room F-677, New York, NY, 10065, USA
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Holzer RJ. “Failure to Rescue”: An Imperfect Measure Well Suited to Complement an Imperfect World. J Am Heart Assoc 2019; 8:e014356. [PMID: 31619105 PMCID: PMC6898857 DOI: 10.1161/jaha.119.014356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ralf J. Holzer
- NewYork‐Presbyterian Komansky Children's Hospital New York NY
- Weill Cornell Medicine New York NY
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Cardiopulmonary Resuscitation in the Pediatric Cardiac Catheterization Laboratory: A Report From the American Heart Association's Get With the Guidelines-Resuscitation Registry. Pediatr Crit Care Med 2019; 20:1040-1047. [PMID: 31232852 DOI: 10.1097/pcc.0000000000002038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hospitalized children with underlying heart disease are at high risk for cardiac arrest, particularly when they undergo invasive catheterization procedures for diagnostic and therapeutic interventions. Outcomes for children experiencing cardiac arrest in the cardiac catheterization laboratory remain under-reported with few studies reporting survival beyond the catheterization laboratory. We aim to describe survival outcomes after cardiac arrest in the cardiac catheterization laboratory while identifying risk factors associated with hospital mortality after these events. DESIGN Retrospective observational study of data from a multicenter cardiac arrest registry from November 2005 to November 2016. Cardiac arrest in the cardiac catheterization laboratory was defined as the need for chest compressions greater than or equal to 1 minute in the cardiac catheterization laboratory. Primary outcome was survival to discharge. Variables analyzed using generalized estimating equations for association with survival included age, illness category (surgical cardiac, medical cardiac), preexisting conditions, pharmacologic interventions, and event duration. SETTING American Heart Association's Get With the Guidelines-Resuscitation registry of in-hospital cardiac arrest. PATIENTS Consecutive patients less than 18 years old experiencing an index (i.e., first) cardiac arrest event reported to the Get With the Guidelines-Resuscitation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 203 patients met definition of index cardiac arrest in the cardiac catheterization laboratory composed primarily of surgical and medical cardiac patients (54% and 41%, respectively). Children less than 1 year old comprised the majority of patients, 58% (117/203). Overall survival to hospital discharge was 69% (141/203). No differences in survival were observed between surgical and medical cardiac patients (p = 0.15). The majority of deaths (69%, 43/62) occurred in patients less than 1 year old. Bradycardia (with pulse) followed by pulseless electrical activity/asystole were the most common first documented rhythms observed (50% and 27%, respectively). Preexisting metabolic/electrolyte abnormalities (p = 0.02), need for vasoactive infusions (p = 0.03) prior to arrest, and use of calcium products (p = 0.005) were found to be significantly associated with lower rates of survival to discharge on multivariable regression. CONCLUSIONS The majority of children experiencing cardiac arrest in the cardiac catheterization laboratory in this large multicenter registry analysis survived to hospital discharge, with no observable difference in outcomes between surgical and medical cardiac patients. Future investigations that focus on stratifying medical complexity in addition to procedural characteristics at the time of catheterization are needed to better identify risks for mortality after cardiac arrest in the cardiac catheterization laboratory.
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O'Byrne ML, Kennedy KF, Jayaram N, Bergersen LJ, Gillespie MJ, Dori Y, Silber JH, Kawut SM, Rome JJ, Glatz AC. Failure to Rescue as an Outcome Metric for Pediatric and Congenital Cardiac Catheterization Laboratory Programs: Analysis of Data From the IMPACT Registry. J Am Heart Assoc 2019; 8:e013151. [PMID: 31619106 PMCID: PMC6898805 DOI: 10.1161/jaha.119.013151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Risk‐adjusted adverse event (AE) rates have been used to measure the quality of pediatric and congenital cardiac catheterization laboratories. In other settings, failure to rescue (FTR) has demonstrated utility as a quality metric. Methods and Results A multicenter retrospective cohort study was performed using data from the IMPACT (Improving Adult and Congenital Treatment) Registry between January 2010 and December 2016. A modified FTR metric was developed for pediatric and congenital cardiac catheterization laboratories and then compared with pooled AEs. The associations between patient‐ and hospital‐level factors and outcomes were evaluated using hierarchical logistic regression models. Hospital risk standardized ratios were then calculated. Rankings of risk standardized ratios for each outcome were compared to determine whether AEs and FTR identified the same high‐ and low‐performing centers. During the study period, 77 580 catheterizations were performed at 91 hospitals. Higher annual hospital catheterization volume was associated with lower odds of FTR (odds ratio: 0.68 per 300 cases; P=0.0003). No association was seen between catheterization volume and odds of AEs. Odds of AEs were instead associated with patient‐ and procedure‐level factors. There was no correlation between risk standardized ratio ranks for FTR and pooled AEs (P=0.46). Hospital ranks by catheterization volume and FTR were associated (r=−0.28, P=0.01) with the largest volume hospitals having the lowest risk of FTR. Conclusions In contrast to AEs, FTR was not strongly associated with patient‐ and procedure‐level factors and was significantly associated with pediatric and congenital cardiac catheterization laboratory volume. Hospital rankings based on FTR and AEs were not significantly correlated. We conclude that FTR is a complementary measure of catheterization laboratory quality and should be included in future research and quality‐improvement projects.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA.,Leonard Davis Institute University of Pennsylvania Philadelphia PA.,Center for Cardiovascular Outcomes, Quality, and Evaluative Research University of Pennsylvania Philadelphia PA.,Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia PA
| | - Kevin F Kennedy
- Mid America Heart Institute St. Luke's Health System Kansas City MO
| | - Natalie Jayaram
- Mid America Heart Institute St. Luke's Health System Kansas City MO.,Division of Cardiology Department of Pediatrics Children's Mercy Hospitals and Clinics Kansas City MO
| | - Lisa J Bergersen
- Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Matthew J Gillespie
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA
| | - Yoav Dori
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA
| | - Jeffrey H Silber
- Leonard Davis Institute University of Pennsylvania Philadelphia PA.,Divisions of Hematology Oncology, Critical Care Medicine, and Outcomes Research Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA
| | - Steven M Kawut
- Division of Pulmonary and Critical Care Medicine Hospital of the University of Pennsylvania Department of Medicine Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine The University of Pennsylvania Philadelphia PA
| | - Jonathan J Rome
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA
| | - Andrew C Glatz
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA.,Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia PA
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Kenny DP, Hijazi ZM. Going beyond the high-risk patient: the new boundaries for transcatheter device-focused therapy. Expert Rev Med Devices 2018; 15:645-652. [DOI: 10.1080/17434440.2018.1514255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Damien P. Kenny
- Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Dublin, Ireland
| | - Ziyad M. Hijazi
- Sidra Cardiac Program, Weill Cornell Medical College, Sidra Medicine, Doha, Qatar
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O'Byrne ML, Kennedy KF, Kanter JP, Berger JT, Glatz AC. Risk Factors for Major Early Adverse Events Related to Cardiac Catheterization in Children and Young Adults With Pulmonary Hypertension: An Analysis of Data From the IMPACT (Improving Adult and Congenital Treatment) Registry. J Am Heart Assoc 2018; 7:e008142. [PMID: 29490973 PMCID: PMC5866335 DOI: 10.1161/jaha.117.008142] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac catheterization is the gold standard for assessment and follow-up of patients with pulmonary hypertension (PH). To date, there are limited data about the factors that influence the risk of catastrophic adverse events after catheterization in this population. METHODS AND RESULTS A retrospective multicenter cohort study was performed to measure risk of catastrophic adverse outcomes after catheterization in children and young adults with PH and identify risk factors for these outcomes. All catheterizations in children and young adults, aged 0 to 21 years, with PH at hospitals submitting data to the IMPACT (Improving Adult and Congenital Treatment) registry between January 1, 2011, and December 31, 2015, were studied. Using mixed-effects multivariable regression, we assessed the association between prespecified subject-, procedure-, and center-level covariates and the risk of death, cardiac arrest, or mechanical circulatory support during or after cardiac catheterization. A total of 8111 procedures performed in 7729 subjects at 77 centers were studied. The observed risk of the composite outcome was 1.4%, and the risk of death before discharge was 5.2%. Catheterization in prematurely born neonates and nonpremature infants was associated with increased risk of catastrophic adverse event, as was precatheterization treatment with inotropes and lower systemic arterial saturation. Secondary analyses demonstrated the following: (1) increasing volumes of catheterization in patients with PH were associated with reduced risk of composite outcome (odds ratio, 0.8 per 10 procedures; P=0.002) and (2) increasing pulmonary vascular resistance and pulmonary artery pressures were associated with increased risk (P<0.0001 for both). CONCLUSIONS Young patients with PH are a high-risk population for diagnostic and interventional cardiac catheterization. Hospital experience with PH is associated with reduced risk, independent of total catheterization case volume.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute at the University of Pennsylvania, Philadelphia, PA
| | - Kevin F Kennedy
- Mid America Heart Institute, St Luke's Health System, Kansas City, MO
| | - Joshua P Kanter
- Division of Cardiology, Children's National Health System, Washington, DC
- Department of Pediatrics, George Washington University School of Health Sciences, Washington, DC
| | - John T Berger
- Division of Cardiology, Children's National Health System, Washington, DC
- Department of Pediatrics, George Washington University School of Health Sciences, Washington, DC
| | - Andrew C Glatz
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Jayaram N, Spertus JA, Kennedy KF, Vincent R, Martin GR, Curtis JP, Nykanen D, Moore PM, Bergersen L. Modeling Major Adverse Outcomes of Pediatric and Adult Patients With Congenital Heart Disease Undergoing Cardiac Catheterization: Observations From the NCDR IMPACT Registry (National Cardiovascular Data Registry Improving Pediatric and Adult Congenital Treatment). Circulation 2017; 136:2009-2019. [PMID: 28882885 DOI: 10.1161/circulationaha.117.027714] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Risk standardization for adverse events after congenital cardiac catheterization is needed to equitably compare patient outcomes among different hospitals as a foundation for quality improvement. The goal of this project was to develop a risk-standardization methodology to adjust for patient characteristics when comparing major adverse outcomes in the NCDR's (National Cardiovascular Data Registry) IMPACT Registry (Improving Pediatric and Adult Congenital Treatment). METHODS Between January 2011 and March 2014, 39 725 consecutive patients within IMPACT undergoing cardiac catheterization were identified. Given the heterogeneity of interventional procedures for congenital heart disease, new procedure-type risk categories were derived with empirical data and expert opinion, as were markers of hemodynamic vulnerability. A multivariable hierarchical logistic regression model to identify patient and procedural characteristics predictive of a major adverse event or death after cardiac catheterization was derived in 70% of the cohort and validated in the remaining 30%. RESULTS The rate of major adverse event or death was 7.1% and 7.2% in the derivation and validation cohorts, respectively. Six procedure-type risk categories and 6 independent indicators of hemodynamic vulnerability were identified. The final risk adjustment model included procedure-type risk category, number of hemodynamic vulnerability indicators, renal insufficiency, single-ventricle physiology, and coagulation disorder. The model had good discrimination, with a C-statistic of 0.76 and 0.75 in the derivation and validation cohorts, respectively. Model calibration in the validation cohort was excellent, with a slope of 0.97 (standard error, 0.04; P value [for difference from 1] =0.53) and an intercept of 0.007 (standard error, 0.12; P value [for difference from 0] =0.95). CONCLUSIONS The creation of a validated risk-standardization model for adverse outcomes after congenital cardiac catheterization can support reporting of risk-adjusted outcomes in the IMPACT Registry as a foundation for quality improvement.
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Affiliation(s)
- Natalie Jayaram
- Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S., K.F.K.)
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S., K.F.K.)
| | - Robert Vincent
- Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.)
| | | | - Jeptha P Curtis
- Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.P.C.)
| | - David Nykanen
- Arnold Palmer Hospital for Children and the University of Central Florida, Orlando (D.N.)
| | - Phillip M Moore
- UCSF Benioff Children's Hospital and the University of California, San Francisco (P.M.M.)
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Abstract
We determined the incidence, type, and severity of complications after cardiac catheterisation in children with heart disease in Norway, and we present the results in terms of the International Paediatric and Congenital Cardiac Code (IPCCC) nomenclature for complications. All paediatric cardiac catheterisations in Norway are performed in one clinical centre. All procedures performed during a 5-year period beginning in 2010 were prospectively registered, and medical records for cases with complications were reviewed to confirm the event and to re-classify the type, severity, and attributability of the complication according to the IPCCC nomenclature. Univariate and multivariate analyses were performed to identify possible risk predictors. A total of 1318 catheterisations performed on 941 patients were included in the present study, of which 68% were interventional. The complication and major complication rates were 5.5 and 1.4%, respectively. Trauma to the vessels or the myocardium, haemodynamic adverse events, and arrhythmias were the most common types of complications. In the multivariate model, weight <4 kg (odds ratios, 3.0; 95% confidence intervals: 1.6-5.8) and risk category 5 (odds ratios, 5.1; 95% confidence intervals: 2.1-12.3) were significant risk predictors for any complication. In spite of a high rate of interventions, the complication rates in this study were similar to older studies, but diverging methods and terminology limit the comparability. We strongly suggest general use of the proposed IPCCC classification system for registration and reports of complications for paediatric cardiac catheterisations.
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Relationship between hospital procedure volume and complications following congenital cardiac catheterization: A report from the IMproving Pediatric and Adult Congenital Treatment (IMPACT) registry. Am Heart J 2017; 183:118-128. [PMID: 27979036 DOI: 10.1016/j.ahj.2016.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The association between institutional volume and outcomes has been demonstrated for cardiac catheterization among adults, but less is known about this relationship for patients with congenital heart disease (CHD) undergoing cardiac catheterization. METHODS Within the IMPACT registry, we identified all catheterizations between January 2011 and March 2015. Hierarchical logistic regression, adjusted for patient and procedural characteristics, was used to determine the association between annual catheterization lab volume and occurrence of a major adverse event (MAE). RESULTS Of 56,453 catheterizations at 77 hospitals, an MAE occurred in 1014 (1.8%) of cases. In unadjusted analysis, a MAE occurred in 2.8% (123/4460) of cases at low-volume hospitals (<150 procedures annually), as compared with 1.5% (198/12,787), 2.0% (431/21,391), and 1.5% (262/17,815) of cases at medium- (150-299 annual procedures), high- (300-499 annual procedures), and very-high-volume (≥500 procedures annually) hospitals, respectively, P<.001. After multivariable adjustment, this significant relationship between annual procedure volume and occurrence of an MAE persisted. Compared to low-volume programs, the odds of an MAE was 0.55 (95% CI 0.35-0.86, P=.008), 0.62 (95% CI 0.41-0.95, P=.03), and 0.52 (95% CI 0.31-0.90, P=.02) at medium-, high-, and very-high-volume programs, respectively. CONCLUSIONS Although the risk of MAE after cardiac catheterization in patients with CHD is low at all hospitals, it is higher among hospitals with fewer than 150 cases annually. These results support the notion that centers meeting this threshold volume for congenital cardiac catheterizations may achieve improved patient outcomes.
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Predictors of Catastrophic Adverse Outcomes in Children With Pulmonary Hypertension Undergoing Cardiac Catheterization: A Multi-Institutional Analysis From the Pediatric Health Information Systems Database. J Am Coll Cardiol 2015; 66:1261-1269. [PMID: 26361158 DOI: 10.1016/j.jacc.2015.07.032] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/12/2015] [Accepted: 07/06/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and longitudinal follow-up of children and adults with pulmonary hypertension (PH). However, the procedure is invasive and has risks associated with both the procedure and recovery period. OBJECTIVES The purpose of this study was to identify risk factors for catastrophic adverse outcomes in children with PH undergoing cardiac catheterization. METHODS We studied children and young adults up to 21 years of age with PH undergoing 1 or more cardiac catheterization at centers participating in the Pediatric Health Information Systems database between 2007 and 2012. Using mixed-effects multivariable regression, we assessed the association between pre-specified subject- and procedure-level covariates and the risk of the composite outcome of death or initiation of mechanical circulatory support within 1 day of cardiac catheterization after adjustment for patient- and procedure-level factors. RESULTS A total of 6,339 procedures performed on 4,401 patients with a diagnosis of PH from 38 of 43 centers contributing data to the Pediatric Health Information Systems database were included. The observed risk of composite outcome was 3.5%. In multivariate modeling, the adjusted risk of the composite outcome was 3.3%. Younger age at catheterization, cardiac operation in the same admission as the catheterization, pre-procedural systemic vasodilator infusion, and hemodialysis were independently associated with an increased risk of adverse outcomes. Pre-procedural use of pulmonary vasodilators was associated with reduced risk of composite outcome. CONCLUSIONS The risk of cardiac catheterization in children and young adults with PH is high relative to previously reported risk in other pediatric populations. The risk is influenced by patient-level factors. Further research is necessary to determine whether knowledge of these factors can be translated into practices that improve outcomes for children with PH.
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Shafer K, Gurvitz M. Evaluation of Health Care Quality in Adults with Congenital Heart Disease. Cardiol Clin 2015; 33:635-41, ix-x. [DOI: 10.1016/j.ccl.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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O'Byrne ML, Glatz AC, Shinohara RT, Jayaram N, Gillespie MJ, Dori Y, Rome JJ, Kawut S. Effect of center catheterization volume on risk of catastrophic adverse event after cardiac catheterization in children. Am Heart J 2015; 169:823-832.e5. [PMID: 26027620 DOI: 10.1016/j.ahj.2015.02.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Procedural volume has been shown to be associated with outcome in cardiac catheterization and intervention in adults. The impact of center-level factors (such as volume) and their interaction with subject- and procedure-level factors on outcome after cardiac catheterization in children is not well described. We hypothesized that higher center catheterization volume would be associated with lower risk of catastrophic adverse events. METHODS We studied children and young adults 0 to 21 years of age undergoing one or more cardiac catheterizations at centers participating in the Pediatric Health Information Systems database between 2007 and 2012. Using mixed-effects multivariable regression, we assessed the association between center catheterization volumes and the risk of a composite outcome of death and/or initiation of mechanical circulatory support within 1 day of cardiac catheterization adjusting for patient- and procedure-level factors. RESULTS A total of 63,994 procedures performed on 40,612 individuals from 38 of 43 centers contributing data to the Pediatric Health Information Systems database were included. The adjusted risk of the composite outcome was 0.1%. Increasing annual catheterization laboratory volume was independently associated with reduced risk of the composite outcome (odds ratio per a 100-procedure/y increment 0.78 [95% CI 0.65-0.93], P < .006). Younger age at catheterization, previous cardiac operation in the same admission as the catheterization, preprocedural vasoactive medications, and hemodialysis were also independently associated with an increased risk of adverse outcomes. CONCLUSIONS Higher cardiac catheterization laboratory volume was associated with reduced risk of catastrophic adverse outcome in the immediate postcatheterization period in children. The observed benefit of catheterization at a larger volume center may be attributable to transmissible best practices or inextricable benefits of larger systems.
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