1
|
Ramlakhan KP, Roos-Hesselink JW, Basso T, Greenslade J, Flint RB, Krieger EV, Shotan A, Budts W, De Backer J, Hall R, Johnson MR, Parsonage WA. Perinatal outcomes after in-utero exposure to beta-blockers in women with heart disease: Data from the ESC EORP registry of pregnancy and cardiac disease (ROPAC). Int J Cardiol 2024; 410:132234. [PMID: 38844094 DOI: 10.1016/j.ijcard.2024.132234] [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: 01/24/2024] [Revised: 05/20/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Beta-blockers are commonly used drugs during pregnancy, especially in women with heart disease, and are regarded as relatively safe although evidence is sparse. Differences between beta-blockers are not well-studied. METHODS In the Registry of Pregnancy And Cardiac disease (ROPAC, n = 5739), a prospective global registry of pregnancies in women with structural heart disease, perinatal outcomes (small for gestational age (SGA), birth weight, neonatal congenital heart disease (nCHD) and perinatal mortality) were compared between women with and without beta-blocker exposure, and between different beta-blockers. Multivariable regression analysis was used for the effect of beta-blockers on birth weight, SGA and nCHD (after adjustment for maternal and perinatal confounders). RESULTS Beta-blockers were used in 875 (15.2%) ROPAC pregnancies, with metoprolol (n = 323, 37%) and bisoprolol (n = 261, 30%) being the most frequent. Women with beta-blocker exposure had more SGA infants (15.3% vs 9.3%, p < 0.001) and nCHD (4.7% vs 2.7%, p = 0.001). Perinatal mortality rates were not different (1.4% vs 1.9%, p = 0.272). The adjusted mean difference in birth weight was -177 g (-5.8%), the adjusted OR for SGA was 1.7 (95% CI 1.3-2.1) and for nCHD 2.3 (1.6-3.5). With metoprolol as reference, labetalol (0.2, 0.1-0.4) was the least likely to cause SGA, and atenolol (2.3, 1.1-4.9) the most. CONCLUSIONS In women with heart disease an association was found between maternal beta-blocker use and perinatal outcomes. Labetalol seems to be associated with the lowest risk of developing SGA, while atenolol should be avoided.
Collapse
Affiliation(s)
- Karishma P Ramlakhan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Thomas Basso
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jaimi Greenslade
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Australian Centre for Health Services Innovation, School of Public Health and Social Work, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Robert B Flint
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric V Krieger
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Avraham Shotan
- Heart Institute, Laniado Medical Center, Netanya, Adelson School of Medicine, Ariel University, Israel
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, and Department of Cardiovascular Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Julie De Backer
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Roger Hall
- Department of Cardiology, University of East Anglia, Norwich, United Kingdom
| | - Mark R Johnson
- Department of Obstetric Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - William A Parsonage
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Australian Centre for Health Services Innovation, School of Public Health and Social Work, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
2
|
Celermajer DS. National Standards of Care for Childhood-onset Heart Disease (CoHD)-A New Paradigm Whereby Healthcare Professionals, Governments and Consumers Work Together to Optimise Patient Care. Heart Lung Circ 2024; 33:147-149. [PMID: 38350798 DOI: 10.1016/j.hlc.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- David S Celermajer
- Faculty of Medicine and Health, University of Sydney, Sydney; Department of Cardiology, Royal Prince Alfred Hospital, Sydney; and, Heart Research Institute, Sydney, NSW, Australia.
| |
Collapse
|
3
|
Sholler GF, Selbie LA, Tallon M, Keating J, Ayer J, Burchill L, Cheung MMH, Cordina R, Culnane E, Donovan S, Eastaugh L, Elliott C, Fletcher J, Justo RN, Kasparian NA, Kelly A, Morsman D, Nicolae M, Orr Y, Pendrick E, Ramsay JM, Reményi B, Shipton S, Weintraub RG, Van Wijk E, Wheaton G, Venugopal P. Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards). 1st Edition. Heart Lung Circ 2024; 33:153-196. [PMID: 38453293 DOI: 10.1016/j.hlc.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 03/09/2024]
Abstract
These first Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards) have been developed to inform the healthcare requirements for CoHD services and enable all Australian patients, families and carers impacted by CoHD (paediatric CoHD and adult congenital heart disease [ACHD]) to live their best and healthiest lives. The CoHD Standards are designed to provide the clarity and certainty required for healthcare services to deliver excellent, comprehensive, inclusive, and equitable CoHD care across Australia for patients, families and carers, and offer an iterative roadmap to the future of these services. The CoHD Standards provide a framework for excellent CoHD care, encompassing key requirements and expectations for whole-of-life, holistic and connected healthcare service delivery. The CoHD Standards should be implemented in health services in conjunction with the National Safety and Quality Health Service Standards developed by the Australian Commission on Safety and Quality in Health Care. All healthcare services should comply with the CoHD Standards, as well as working to their organisation's or jurisdiction's agreed clinical governance framework, to guide the implementation of structures and processes that support safe care.
Collapse
Affiliation(s)
- Gary F Sholler
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Lisa A Selbie
- HeartKids Ltd, Parramatta, NSW, Australia; School of Biotechnology & Biomolecular Sciences University of NSW, Sydney, NSW, Australia and Johns Hopkins University, Baltimore, MD, USA
| | - Mary Tallon
- HeartKids Ltd, Parramatta, NSW, Australia; Perth Children's Hospital, Perth, WA, Australia; School of Nursing, Curtin University, Perth, WA, Australia
| | | | - Julian Ayer
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Luke Burchill
- The Royal Melbourne Hospital, Melbourne, Vic, Australia and Mayo Clinic, Rochester, New York, NY, USA
| | - Michael M H Cheung
- The University of Melbourne, Melbourne, Vic, Australia; The Royal Children's Hospital, Melbourne, Vic, Australia
| | - Rachael Cordina
- The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Evelyn Culnane
- The Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Lucas Eastaugh
- The Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Jeffery Fletcher
- Queensland Paediatric Specialists, Southport, Qld, Australia; Department of Paediatrics, The Tweed Hospital, Tweed Heads, NSW, Australia and Griffith University, Brisbane, Qld, Australia
| | - Robert N Justo
- Queensland Children's Hospital, South Brisbane, Qld, Australia; The University of Queensland, Herston, Qld, Australia; Queensland Paediatric Cardiac Research, Children's Health Queensland, South Brisbane, Qld, Australia
| | - Nadine A Kasparian
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Ohio, OH, USA
| | - Andrew Kelly
- Women's and Children's Hospital, North Adelaide, SA, Australia
| | | | - Mugur Nicolae
- The University of Queensland, Herston, Qld, Australia; Mater Hospital Services, Brisbane, Qld, Australia
| | - Yishay Orr
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | | | | | - Bo Reményi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT and Royal Darwin Hospital, Darwin, NT, Australia
| | | | - Robert G Weintraub
- The University of Melbourne, Melbourne, Vic, Australia; The Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Elsa Van Wijk
- HeartKids Ltd, Parramatta, NSW, Australia; Australian Institute of Company Directors, NSW, Australia
| | - Gavin Wheaton
- Women's and Children's Hospital, North Adelaide, SA, Australia; University of Adelaide, Adelaide, SA, Australia
| | - Prem Venugopal
- Queensland Children's Hospital, South Brisbane, Qld, Australia; The University of Queensland, Herston, Qld, Australia
| |
Collapse
|
4
|
Lloyd LK, Nicholson C, Strange G, Celermajer DS. The burdensome logistics of data linkage in Australia - the example of a national registry for congenital heart disease. AUST HEALTH REV 2024; 48:8-15. [PMID: 38118279 DOI: 10.1071/ah23185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023]
Abstract
Objective Data linkage is a very powerful research tool in epidemiology, however, establishing this can be a lengthy and intensive process. This paper reports on the complex landscape of conducting data linkage projects in Australia. Methods We reviewed the processes, required documentation, and applications required to conduct multi-jurisdictional data linkage across Australia, in 2023. Results Obtaining the necessary approvals to conduct linkage will likely take nearly 2 years (estimated 730 days, including 605 days from initial submission to obtaining all ethical approvals and an estimated further 125 days for the issuance of unexpected additionally required approvals). Ethical review for linkage projects ranged from 51 to 128 days from submission to ethical approval, and applications consisted of 9-25 documents. Conclusions Major obstacles to conducting multi-jurisdictional data linkage included the complexity of the process, and substantial time and financial costs. The process was characterised by inefficiencies at several levels, reduplication, and a lack of any key accountabilities for timely performance of processes. Data linkage is an invaluable resource for epidemiological research. Further streamlining, establishing accountability, and greater collaboration between jurisdictions is needed to ensure data linkage is both accessible and feasible to researchers.
Collapse
Affiliation(s)
- Larissa K Lloyd
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia; and Cardiology Department, Royal Prince Alfred Hospital, Level 6, Building 75, Missenden Road, Camperdown, Sydney, NSW 2050, Australia; and Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Calum Nicholson
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia; and Cardiology Department, Royal Prince Alfred Hospital, Level 6, Building 75, Missenden Road, Camperdown, Sydney, NSW 2050, Australia; and Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Geoff Strange
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia; and Cardiology Department, Royal Prince Alfred Hospital, Level 6, Building 75, Missenden Road, Camperdown, Sydney, NSW 2050, Australia; and Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - David S Celermajer
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia; and Cardiology Department, Royal Prince Alfred Hospital, Level 6, Building 75, Missenden Road, Camperdown, Sydney, NSW 2050, Australia; and Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
5
|
Nicholson C, Hanly M, Celermajer DS. An interactive geographic information system to inform optimal locations for healthcare services. PLOS DIGITAL HEALTH 2023; 2:e0000253. [PMID: 37155602 PMCID: PMC10166531 DOI: 10.1371/journal.pdig.0000253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
Large health datasets can provide evidence for the equitable allocation of healthcare resources and access to care. Geographic information systems (GIS) can help to present this data in a useful way, aiding in health service delivery. An interactive GIS was developed for the adult congenital heart disease service (ACHD) in New South Wales, Australia to demonstrate its feasibility for health service planning. Datasets describing geographic boundaries, area-level demographics, hospital driving times, and the current ACHD patient population were collected, linked, and displayed in an interactive clinic planning tool. The current ACHD service locations were mapped, and tools to compare current and potential locations were provided. Three locations for new clinics in rural areas were selected to demonstrate the application. Introducing new clinics changed the number of rural patients within a 1-hour drive of their nearest clinic from 44·38% to 55.07% (79 patients) and reduced the average driving time from rural areas to the nearest clinic from 2·4 hours to 1·8 hours. The longest driving time was changed from 10·9 hours to 8·9 hours. A de-identified public version of the GIS clinic planning tool is deployed at https://cbdrh.shinyapps.io/ACHD_Dashboard/. This application demonstrates how a freely available and interactive GIS can be used to aid in health service planning. In the context of ACHD, GIS research has shown that adherence to best practice care is impacted by patients' accessibility to specialist services. This project builds on this research by providing opensource tools to build more accessible healthcare services.
Collapse
Affiliation(s)
- Calum Nicholson
- Central Clinical School, University of Sydney Faculty of Medicine and Health, Darlington, New South Wales, Australia
- Clinical Research Group, Heart Research Institute, Newtown, New South Wales, Australia
- Cardiology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Mark Hanly
- Centre for Big Data Research in Health, University of New South Wales, Kensington, New South Wales, Australia
| | - David S Celermajer
- Central Clinical School, University of Sydney Faculty of Medicine and Health, Darlington, New South Wales, Australia
- Clinical Research Group, Heart Research Institute, Newtown, New South Wales, Australia
- Cardiology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| |
Collapse
|
6
|
Administration of a National Disease Registry in Australia: Lessons from the Development of the CHAANZ Congenital Heart Disease Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
7
|
Commentary on "Motor Developmental Delay After Cardiac Surgery in Children With a Critical Congenital Heart Defect: A Systematic Literature Review and Meta-analysis". Pediatr Phys Ther 2021; 33:198-199. [PMID: 34618743 DOI: 10.1097/pep.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Percin L, Brida M. Congenital heart disease registries: Vast room for improvement. Int J Cardiol 2021; 339:43-44. [PMID: 34256068 DOI: 10.1016/j.ijcard.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Luka Percin
- Division for Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Croatia
| | - Margarita Brida
- Division for Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Croatia; Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, London, UK; Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Croatia.
| |
Collapse
|
9
|
Chami J, Nicholson C, Strange G, Cordina R, Celermajer DS. National and regional registries for congenital heart diseases: Strengths, weaknesses and opportunities. Int J Cardiol 2021; 338:89-94. [PMID: 33965467 DOI: 10.1016/j.ijcard.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aim to establish a new and informative bi-national Registry for Congenital Heart Disease (CHD) patients in Australia and New Zealand, to document the burden of disease and clinical outcomes for patients with CHDs across the lifespan. When planning for the implementation of this Registry, we sought to evaluate the strengths and weaknesses of existing national and large regional CHD databases. METHODS We characterised 15 large multi-institutional databases of pediatric and/or adult patients with CHD, documenting the richness of their datasets, the ease of linkage to other databases, the coverage of the target cohort and the strategies utilised for quality control. RESULTS The best databases contained demographic, clinical, physical, laboratory and patient-reported data, and were linked at least to the national/regional death registry. They also employed automatic data verification and regular manual audits. Coverage ranged from around 25% of all eligible CHD cases for larger databases to near 100% for some smaller registries of patients with specific CHD lesions, such as the Australia and New Zealand Fontan Registry. CONCLUSIONS Existing national and regional CHD databases have strengths and weaknesses; few combine complete coverage with high quality and regularly audited data, across the broad range of CHDs.
Collapse
Affiliation(s)
- Jason Chami
- Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia
| | - Calum Nicholson
- Heart Research Institute, 7 Eliza St, Newtown, NSW 2042, Australia
| | - Geoff Strange
- School of Medicine, University of Notre Dame Australia, 21 Henry St, Freemantle, WA 6160, Australia
| | - Rachael Cordina
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - David S Celermajer
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia.
| |
Collapse
|
10
|
Sood E, Lisanti AJ, Woolf-King SE, Wray J, Kasparian N, Jackson E, Gregory MR, Lopez KN, Marino BS, Neely T, Randall A, Zyblewski SC, Brosig CL. Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2021; 31:900-914. [PMID: 34082841 PMCID: PMC8759239 DOI: 10.1017/s1047951121002134] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.
Collapse
Affiliation(s)
- Erica Sood
- Nemours Cardiac Center & Nemours Center for Healthcare Delivery Science, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy Jo Lisanti
- Department of Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Jo Wray
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nadine Kasparian
- Cincinnati Children’s Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Heart Centre for Children, The Sydney Children’s Hospitals Network, Sydney, Australia
| | - Emily Jackson
- Department of Patient and Family Services, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Mary R. Gregory
- Department of Nursing, School of Nursing and Health Professions, Missouri Western State University, Saint Joseph, Missouri, USA
- Department of Developmental Medicine/Behavior Sciences, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Keila N. Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | - Trent Neely
- Sisters by Heart/Brothers by Heart, El Segundo, California, USA
| | - Amy Randall
- Mended Little Hearts of Wisconsin, Mended Hearts/Mended Little Hearts, Albany, Georgia, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
11
|
Strange GA, Veerappan S, Alphonso N, Refeld S, Simon S, Justo R. Prevalence and Cost of Managing Paediatric Cardiac Disease in Queensland. Heart Lung Circ 2020; 30:254-260. [PMID: 32718902 DOI: 10.1016/j.hlc.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/17/2020] [Accepted: 06/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a paucity of contemporary information regarding the prevalence and related health care expenditure of the most common cardiac conditions in Australian children, including congenital heart disease (CHD). METHODS The 10 most common cardiac conditions managed by Queensland Paediatric Cardiac Service during 2014-2015 were identified from an electronic database: ventricular septal defect (VSD), pulmonary stenosis, aortic stenosis, tetralogy of Fallot, atrioventricular septal defect, transposition, Ebstein's anomaly, long QT syndrome, dilated cardiomyopathy, and rheumatic carditis. Demographic data, clinic attendance, investigational procedures, and therapeutic interventions were extracted from the electronic health records to derive indicative population estimates and direct health care expenditure relating to CHD. RESULTS A total of 2,519 patients diagnosed with the 10 target conditions were being actively managed, including 456 (18.1%) new-born and 787 prevalent cases (2.5/1,000 population) aged <5 years. A total of 12,180 (4.8/case) investigations were performed (6,169 echocardiographic and 279 cardiac catheterisation procedures) costing $2.25 million/annum. A further 5,326 clinic visits (2.1/case, 22% regional) were conducted at a cost of $550,000/annum. A combined total of 804 catheter-based interventions and surgical procedures were performed in 300 cases (11.9%) at a cost of $13.6 million/annum. VSD (38.6% of cases) was the single greatest contributor ($5.1 million/annum) to total combined direct health care costs of $13.6 million/annum for the 2,519 patients. CONCLUSIONS These pilot data indicate a significant patient population and health care burden imposed by CHD in Queensland. Future initiatives to better quantify this burden, from an individual to health system perspective, are urgently needed.
Collapse
Affiliation(s)
- Geoffrey A Strange
- School of Medicine, University of Notre Dame, Freemantle, WA, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Sundar Veerappan
- Queensland Children's Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Nelson Alphonso
- Queensland Children's Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Stephen Refeld
- Queensland Children's Hospital, Brisbane, Qld, Australia
| | - Stewart Simon
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Torrens University Australia, Adelaide, SA, Australia
| | - Robert Justo
- Queensland Children's Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia
| |
Collapse
|
12
|
Heart Disease and Pregnancy: The Need for a Twenty-First Century Approach to Care…. Heart Lung Circ 2020; 30:45-51. [PMID: 32778509 DOI: 10.1016/j.hlc.2020.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/18/2020] [Accepted: 06/15/2020] [Indexed: 11/23/2022]
Abstract
Pregnancy and childbirth present a specific challenge to the maternal cardiovascular system. Pre-existing cardiac diseases, or cardiac diseases that occur during pregnancy, are associated with a significant risk of morbidity and mortality for both mother and baby. In recent decades, cardiac disease has emerged as a leading cause of maternal death in most high income countries, including Australia and New Zealand. The burden of cardiac disease in pregnancy is likely to be growing due to an increase in adult survivors with congenital heart disease embarking on pregnancy coupled with demographic shifts in the age and cardiovascular risk factors of women giving birth and the persisting high incidence of acute rheumatic fever in First Nations women. There is widespread consensus that the best obstetric and neonatal outcomes in women with cardiac disease are delivered by a strategy of carefully coordinated multidisciplinary care. Australia and New Zealand currently lack nationally agreed strategies for clinical practice and service delivery for women with heart disease in pregnancy. This state-of-the-art review summarises some of the key issues faced in relation to prevention, diagnosis, treatment and health service delivery in this patient group and concludes with suggested priorities for policy and research.
Collapse
|
13
|
Zentner D, Celermajer DS, Gentles T, d’Udekem Y, Ayer J, Blue GM, Bridgman C, Burchill L, Cheung M, Cordina R, Culnane E, Davis A, du Plessis K, Eagleson K, Finucane K, Frank B, Greenway S, Grigg L, Hardikar W, Hornung T, Hynson J, Iyengar AJ, James P, Justo R, Kalman J, Kasparian N, Le B, Marshall K, Mathew J, McGiffin D, McGuire M, Monagle P, Moore B, Neilsen J, O’Connor B, O’Donnell C, Pflaumer A, Rice K, Sholler G, Skinner JR, Sood S, Ward J, Weintraub R, Wilson T, Wilson W, Winlaw D, Wood A. Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement. Heart Lung Circ 2020; 29:5-39. [DOI: 10.1016/j.hlc.2019.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Early Emotional, Behavioural and Social Development of Infants and Young Children with Congenital Heart Disease: A Systematic Review. J Clin Psychol Med Settings 2019; 27:686-703. [PMID: 31506852 DOI: 10.1007/s10880-019-09651-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The experiences of diagnosis of congenital heart disease (CHD), cardiac surgery and hospitalisation(s) are distressing and represent a significant stressor for a child and family, which may impact psychosocial development. This systematic review provides a synthesis of psychosocial outcomes of infants and young children with congenital heart disease who had cardiac surgery early in life. Twenty-eight studies related to infant and young children's psychosocial development, specifically emotional, social and behavioural functioning were identified. Variability was related to methodological factors including differences in study design, varying measurement tools and heterogeneous samples. Despite these limitations, the majority of studies were of high quality. The most common finding was a high prevalence of low-severity emotional and behavioural dysregulation. Young children with severe CHD or comorbid conditions experienced greater impairment, with higher rates of externalising behaviour problems, although internalising behaviour problems were also evident. This review integrates findings from literature in the past 28 years on the psychosocial well-being of infants and young children with CHD and demonstrates a risk for emotional, social and behavioural development difficulty, and, importantly, that symptoms of psychosocial impairment are detectable very early in infancy. We advocate for assessment and monitoring of emotional and behavioural regulation and social development to be routinely conducted from infancy to enable prevention and early intervention.
Collapse
|
16
|
Nicolae M, Gentles T, Strange G, Tanous D, Disney P, Bullock A, Grigg L, Chen SS, Pressley L, Cordina R, Hornung T, O’Donnell C, Celermajer DS. Adult Congenital Heart Disease in Australia and New Zealand: A Call for Optimal Care. Heart Lung Circ 2019; 28:521-529. [DOI: 10.1016/j.hlc.2018.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/29/2018] [Accepted: 10/08/2018] [Indexed: 11/15/2022]
|
17
|
Strange G, Stewart S, Farthing M, Kasparian NA, Selbie L, O'Donnell C, Ayer J, Cordina R, Celermajer D. Living With, and Caring for, Congenital Heart Disease in Australia: Insights From the Congenital Heart Alliance of Australia and New Zealand Online Survey. Heart Lung Circ 2019; 29:216-223. [PMID: 30826267 DOI: 10.1016/j.hlc.2018.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a paucity of data describing the day-to-day experiences of adult Australians personally living with or caring for a child born with congenital heart disease (CHD). Such data would be of great practical importance to inform health care initiatives to improve outcomes. METHODS 588 men (38.3 ± 11.9 years) and women (39.6 ± 12.6 years, 78% of respondent patients) living with CHD and 1,091 adult carers (93% mothers) of children with CHD (median age 7.3 [IQR 3.5-13.3 years], 54% male), representing all Australian states and territories, responded to a comprehensive online survey designed and hosted by the Congenital Heart Alliance of Australia and New Zealand. Data on demographic factors, the nature of underlying CHD, interactions with health care services, psychological wellbeing and wider impacts of CHD were collected. RESULTS Most respondents were able to identify the type of CHD they (29% with a simple lesion such atrial septal defect, 17% tetralogy of Fallot) or their child had (21% with a simple lesion, 15% tetralogy of Fallot), whilst 90% cases of CHD had undergone cardiac surgery. Patients with CHD were mostly employed (70%) or studying (8.8%), whilst 9.1% were receiving disability benefits. In terms of transition care, 52% of adult patients had been referred by a paediatric to adult cardiologist with 84% still actively managed by a specialist. Overall, 31% of patients with CHD sought emergency care and required >10 days sick leave in the past 12 months. Moreover, 71% and 55% of patients, respectively, reported recent feelings of anxiety/worry or depressive thoughts related to their CHD (61% sought professional assistance). Consistent with high levels of disruption to daily living, 59% of carer respondents (24%>10 days) had taken carer's leave in the past 12 months. CONCLUSIONS These contemporary, self-reported, Australian data reveal the burden of living and caring for CHD from an adult's perspective. Survey respondents highlighted the potential disconnect between paediatric and adult CHD services and suggest an important, unmet need for dedicated health services/community care to cost-effectively manage high levels of health care utilisation coupled with associated psychological distress.
Collapse
Affiliation(s)
- Geoff Strange
- School of Medicine, University of Notre Dame, Freemantle, Perth, WA, Australia.
| | - Simon Stewart
- Hatter Institute, University of Cape Town, Cape Town, South Africa
| | - Melissa Farthing
- Congenital Heart Alliance of Australia and New Zealand, Sydney, NSW, Australia
| | | | | | - Clare O'Donnell
- Green Lane Paediatric and Congenital Heart Service, Starship/Auckland City Hospitals, Auckland, New Zealand
| | - Julian Ayer
- The Heart Centre for Children, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Rachael Cordina
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - David Celermajer
- Faculty of Medicine and Health, University of Sydney, Heart Research Institute, Sydney, NSW, Australia
| |
Collapse
|
18
|
Wacker J, Weintraub RG. Macitentan in Pulmonary Arterial Hypertension Associated with Congenital Heart Defects. Heart Lung Circ 2018; 26:1006-1007. [PMID: 28867027 DOI: 10.1016/j.hlc.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Julie Wacker
- Department of Cardiology, Royal Children's Hospital, Melbourne, Vic, Australia
| | - Robert G Weintraub
- Department of Cardiology, Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| |
Collapse
|
19
|
Kasparian NA, De Abreu Lourenco R, Winlaw DS, Sholler GF, Viney R, Kirk EPE. Tell me once, tell me soon: parents' preferences for clinical genetics services for congenital heart disease. Genet Med 2018; 20:1387-1395. [PMID: 29493584 DOI: 10.1038/gim.2018.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/18/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE As the molecular basis of congenital heart disease (CHD) comes into sharper focus, cardiac genetics services are likely to play an increasingly important role. This study aimed to identify parents' preferences for, and willingness to participate in, clinical genetics services for CHD. METHODS A discrete choice experiment was developed to assess parents' preferences for pediatric cardiogenetics services based on four attributes: appointment format, health professionals involved, waiting time, and information format. Data were analyzed using a mixed logit model. RESULTS One hundred parents with a living child diagnosed with CHD requiring surgical intervention between 2000 and 2009 completed the discrete choice experiment. Parents expressed a clear preference for cardiac genetics services featuring (i) a single appointment, (ii) the presence of a clinical geneticist and a genetic counselor, (iii) both verbal (oral) and Web-based information about CHD and genetics, and (iv) availability of an appointment within 2 weeks. If offered such conditions, 93% of respondents indicated that they would attend. The choice of service was most strongly influenced by the presence of both a clinical geneticist and a genetic counselor. CONCLUSION Parents of children with CHD favor a single, timely genetics appointment with both a geneticist and a genetic counselor present. If appointments offered match these preferences, uptake is likely to be high.
Collapse
Affiliation(s)
- Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia. .,Heart Centre for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, New South Wales, Australia.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David S Winlaw
- Heart Centre for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Edwin P E Kirk
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Medical Genetics, Sydney Children's Hospital, Randwick, New South Wales, Australia
| |
Collapse
|
20
|
Adult congenital heart disease in Greece: Preliminary data from the CHALLENGE registry. Int J Cardiol 2017; 245:109-113. [PMID: 28743482 DOI: 10.1016/j.ijcard.2017.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The majority of patients with congenital heart disease (CHD), nowadays, survives into adulthood and is faced with long-term complications. We aimed to study the basic demographic and clinical characteristics of adult patients with congenital heart disease (ACHD) in Greece. METHODS A registry named CHALLENGE (Adult Congenital Heart Disease Registry. A registry from Hellenic Cardiology Society) was initiated in January 2012. Patients with structural CHD older than 16years old were enrolled by 16 specialized centers nationwide. RESULTS Out of a population of 2115 patients with ACHD, who have been registered, (mean age 38years (SD 16), 52% women), 47% were classified as suffering from mild, 37% from moderate and 15% from severe ACHD. Atrial septal defect (ASD) was the most prevalent diagnosis (33%). The vast majority of ACHD patients (92%) was asymptomatic or mildly symptomatic (NYHA class I/II). The most symptomatic patients were suffering from an ASD, most often the elderly or those under targeted therapy for pulmonary arterial hypertension. Elderly patients (>60years old) accounted for 12% of the ACHD population. Half of patients had undergone at least one open-heart surgery, while 39% were under cardiac medications (15% under antiarrhythmic drugs, 16% under anticoagulants, 16% under medications for heart failure and 4% under targeted therapy for pulmonary arterial hypertension). CONCLUSIONS ACHD patients are an emerging patient population and national prospective registries such as CHALLENGE are of unique importance in order to identify the ongoing needs of these patients and match them with the appropriate resource allocation.
Collapse
|
21
|
Vener DF, Gaies M, Jacobs JP, Pasquali SK. Clinical Databases and Registries in Congenital and Pediatric Cardiac Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide. World J Pediatr Congenit Heart Surg 2016; 8:77-87. [DOI: 10.1177/2150135116681730] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The growth in large-scale data management capabilities and the successful care of patients with congenital heart defects have coincidentally paralleled each other for the last three decades, and participation in multicenter congenital heart disease databases and registries is now a fundamental component of cardiac care. This manuscript attempts for the first time to consolidate in one location all of the relevant databases worldwide, including target populations, specialties, Web sites, and participation information. Since at least 1,992 cardiac surgeons and cardiologists began leveraging this burgeoning technology to create multi-institutional data collections addressing a variety of specialties within this field. Pediatric heart diseases are particularly well suited to this methodology because each individual care location has access to only a relatively limited number of diagnoses and procedures in any given calendar year. Combining multiple institutions data therefore allows for a far more accurate contemporaneous assessment of treatment modalities and adverse outcomes. Additionally, the data can be used to develop outcome benchmarks by which individual institutions can measure their progress against the field as a whole and focus quality improvement efforts in a more directed fashion, and there is increasing utilization combining clinical research efforts within existing data structures. Efforts are ongoing to support better collaboration and integration across data sets, to improve efficiency, further the utility of the data collection infrastructure and information collected, and to enhance return on investment for participating institutions.
Collapse
Affiliation(s)
- David F. Vener
- Department of Anesthesiology, Perioperative and Pain Medicine, Pediatric Cardiovascular Anesthesia, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Michael Gaies
- Department of Pediatric Cardiology, C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey P. Jacobs
- Cardiovascular Surgery, Johns Hopkins All Children’s Hospital, St Petersburg, FL, USA
| | - Sara K. Pasquali
- Department of Pediatric Cardiology, C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
22
|
Gregory AT, Denniss AR. Heart, Lung and Circulation Evolves: A Fond Farewell to Our 25th Anniversary Year and a Warm Welcome to New Initiatives. Heart Lung Circ 2016; 25:1145-1147. [DOI: 10.1016/j.hlc.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
23
|
Kasparian NA, Winlaw DS, Sholler GF. “Congenital heart health”: how psychological care can make a difference. Med J Aust 2016; 205:104-7. [DOI: 10.5694/mja16.00392] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Nadine A Kasparian
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
- University of New South Wales, Sydney, NSW
| | - David S Winlaw
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Gary F Sholler
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| |
Collapse
|