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Cabrera Fernandez DL, Lopez KN, Bravo-Jaimes K, Mackie AS. The Impact of Social Determinants of Health on Transition From Pediatric to Adult Cardiology Care. Can J Cardiol 2024; 40:1043-1055. [PMID: 38583706 DOI: 10.1016/j.cjca.2024.03.023] [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: 12/22/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
Social determinants of health (SDoH) are the economic, social, environmental, and psychosocial factors that influence health. Adolescents and young adults with congenital heart disease (CHD) require lifelong cardiology follow-up and therefore coordinated transition from pediatric to adult healthcare systems. However, gaps in care are common during transition, and they are driven in part by pervasive disparities in SDoH, including race, ethnicity, socioeconomic status, access to insurance, and remote location of residence. These disparities often coexist and compound the challenges faced by patients and families. For example, Black and Indigenous individuals are more likely to be subject to systemic racism and implicit bias within healthcare and other settings, to be unemployed and poor, to have limited access to insurance, and to have a lower likelihood of transfer of care to adult CHD specialists. SDoH also are associated with acquired cardiovascular disease, a comorbidity that adults with CHD face. This review summarizes existing evidence regarding the impact of SDoH on the transition to adult care and proposes strategies at the individual, institutional, and population and/or system levels. to reduce inequities faced by transition-age youth. These strategies include routinely screening for SDoH in clinical settings with referral to appropriate services, providing formal transition education for all transition-age youth, including training on navigating complex medical systems, creating satellite cardiology clinics to facilitate access to care for those who live remote from tertiary centres, advocating for lifelong insurance coverage where applicable, mandating cultural-sensitivity training for providers, and increasing the diversity of healthcare providers in pediatric and adult CHD care.
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Affiliation(s)
- Diana L Cabrera Fernandez
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Keila N Lopez
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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Bravo-Jaimes K, Bullock-Palmer RP. Adult Congenital Heart Disease Scholarship: An Opportunity to Spark Interest in This Field. JACC Case Rep 2023; 24:102022. [PMID: 37869213 PMCID: PMC10589437 DOI: 10.1016/j.jaccas.2023.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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Karsenty C, Djeddai C, Cohen A, Bonnet G, Ma I, Vignaud P, Thambo JB, Di Filippo S, Acar P, Ladouceur M. Training young cardiologists in adult congenital heart disease should be a priority: Results of a French survey. Arch Cardiovasc Dis 2023; 116:167-169. [PMID: 36639299 DOI: 10.1016/j.acvd.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Clément Karsenty
- Paediatric and Adult Congenital Cardiology Unit, CHU Toulouse, 330, avenue de Grande Bretagne, 31059 Toulouse cedex 9, France; Institut des maladies métaboliques et cardiovasculaires, université de Toulouse, Inserm U1048, I2MC, 31432 Toulouse, France.
| | - Camelia Djeddai
- Paediatric and Adult Congenital Cardiology Unit, CHU Toulouse, 330, avenue de Grande Bretagne, 31059 Toulouse cedex 9, France
| | - Ariel Cohen
- Department of Cardiology, Saint-Antoine and Tenon Hospital, AP-HP, Inserm UMRS-ICAN 1166 and Sorbonne université, 75013 Paris, France
| | - Guillaume Bonnet
- Centre de recherche cardiovasculaire de Paris, Inserm U970, 75015 Paris, France
| | - Iris Ma
- Institut des cardiopathies congénitales de Tours, CHRU de Tours, centre hospitalier regional universitaire de Tours, université François-Rabelais, 37000 Tours, France
| | - Paul Vignaud
- Paediatric and Adult Congenital Cardiology Unit, CHU Toulouse, 330, avenue de Grande Bretagne, 31059 Toulouse cedex 9, France
| | - Jean-Benoit Thambo
- Department of Paediatric and Adult Congenital Cardiology, University Hospital of Bordeaux; IHU Liryc, fondation Bordeaux université, centre de recherche cardiothoracique de Bordeaux, Inserm, 33600 Pessac, France
| | - Sylvie Di Filippo
- Service de cardiologie pédiatrique, groupe hospitalier Est, CHU de Lyon, 69677 Bron, France
| | - Philippe Acar
- Paediatric and Adult Congenital Cardiology Unit, CHU Toulouse, 330, avenue de Grande Bretagne, 31059 Toulouse cedex 9, France
| | - Magalie Ladouceur
- Centre de recherche cardiovasculaire de Paris, Inserm U970, 75015 Paris, France; Centre de référence des malformations cardiaques congénitales complexes, M3C, Adult Congenital Heart Disease Unit, hôpital européen Georges-Pompidou, AP-HP, Paris Cité University, 75015 Paris, France
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Steiner JM, Kirkpatrick JN. A view from the end: what the last year of life can teach us about palliative care on the adult congenital heart disease journey. Eur Heart J 2022; 43:4493-4495. [PMID: 36030412 DOI: 10.1093/eurheartj/ehac492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jill M Steiner
- Division of Cardiology, Department of Medicine & Cambia Palliative Care Center of Excellence, University of Washington, 1959 NE Pacific St., HSB C502, Box 356422 Seattle, WA 98195, USA
| | - James N Kirkpatrick
- Division of Cardiology, Department of Medicine & Department of Bioethics and Humanities, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
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Saidi A, Stout KK. RESPONSE: Fostering an ACHD Clinician Pipeline: Keep the Fires Burning. J Am Coll Cardiol 2022; 80:644-645. [PMID: 35926939 DOI: 10.1016/j.jacc.2022.05.048] [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: 11/17/2022]
Affiliation(s)
- Arwa Saidi
- University of Florida, Gainesville, Florida, USA.
| | - Karen K Stout
- University of Washington Medical Center, Seattle, Washington, USA
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