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Robb C, Rajput MZ, Raptis D, Bhalla S. Don't skip a beat! Critical findings in imaging studies performed in adults with congenital heart disease. Curr Probl Diagn Radiol 2024; 53:297-307. [PMID: 38272749 DOI: 10.1067/j.cpradiol.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 12/14/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
With ongoing advances in both medical and surgical management, the population of adults with congenital heart disease (CHD) continues to grow each year and has surpassed the number of pediatric cases. These adult patients will present to adult emergency departments with increasing frequency. Adults with CHD are at increased risk of developing not only cardiovascular complications, such as aortic dissection and thromboemboli, but also abdominopelvic and neurologic processes at younger ages. These individuals are also more likely to develop less urgent but clinically significant complications including end-organ dysfunction, baffle leaks, or bleeding collateral vessels. Ultimately, imaging can play a critical role in determining the triage, diagnosis, and management of adult CHD patients. To accomplish this goal, radiologists must be able to distinguish acute and chronic complications of treated CHD from benign processes, including expected post-surgical changes or imaging artifacts. Radiologists also need to be familiar with the various long-term risks and complications associated with both treated and untreated forms of CHD, particularly those in adults with complex lesions.
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Affiliation(s)
- Caroline Robb
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Boulevard, Campus Box 8131, St. Louis, MO 63110, USA
| | - M Zak Rajput
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Boulevard, Campus Box 8131, St. Louis, MO 63110, USA.
| | - Demetrios Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Boulevard, Campus Box 8131, St. Louis, MO 63110, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Boulevard, Campus Box 8131, St. Louis, MO 63110, USA
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2
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Sakowitz S, Bakhtiyar SS, Ali K, Mallick S, Williamson C, Benharash P. Outcomes following major thoracoabdominal cancer resection in adults with congenital heart disease. PLoS One 2024; 19:e0295767. [PMID: 38165963 PMCID: PMC10760660 DOI: 10.1371/journal.pone.0295767] [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: 05/03/2023] [Accepted: 11/28/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND While advances in medical and surgical management have allowed >97% of congenital heart disease (CHD) patients to reach adulthood, a growing number are presenting with non-cardiovascular malignancies. Indeed, adults with CHD are reported to face a 20% increase in cancer risk, relative to others, and cancer has become the fourth leading cause of death among this population. Surgical resection remains a mainstay in management of thoracoabdominal cancers. However, outcomes following cancer resection among these patients have not been well established. Thus, we sought to characterize clinical and financial outcomes following major cancer resections among adult CHD patients. METHODS The 2012-2020 National Inpatient Sample was queried for all adults (CHD or non-CHD) undergoing lobectomy, esophagectomy, gastrectomy, pancreatectomy, hepatectomy, or colectomy for cancer. To adjust for intergroup differences in baseline characteristics, entropy balancing was applied to generate balanced patient groups. Multivariable models were constructed to assess outcomes of interest. RESULTS Of 905,830 patients undergoing cancer resection, 1,480 (0.2%) had concomitant CHD. The overall prevalence of such patients increased from <0.1% in 2012 to 0.3% in 2012 (P for trend<0.001). Following risk adjustment, CHD was linked with greater in-hospital mortality (AOR 2.00, 95%CI 1.06-3.76), as well as a notable increase in odds of stroke (AOR 8.94, 95%CI 4.54-17.60), but no statistically significant difference in cardiac (AOR 1.33, 95%CI 0.69-2.59) or renal complications (AOR 1.35, 95%CI 0.92-1.97). Further, CHD was associated with a +2.39 day incremental increase in duration of hospitalization (95%CI +1.04-3.74) and a +$11,760 per-patient increase in hospitalization expenditures (95%CI +$4,160-19,360). CONCLUSIONS While a growing number of patients with CHD are undergoing cancer resection, they demonstrate inferior clinical and financial outcomes, relative to others. Novel screening, risk stratification, and perioperative management guidelines are needed for these patients to provide evidence-based recommendations for this complex and unique cohort.
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Affiliation(s)
- Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
- Department of Surgery, University of Colorado, Aurora, CO, United States of America
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Catherine Williamson
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, CA, United States of America
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3
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Changing epidemiology of congenital heart disease: effect on outcomes and quality of care in adults. Nat Rev Cardiol 2023; 20:126-137. [PMID: 36045220 DOI: 10.1038/s41569-022-00749-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
The epidemiology of congenital heart disease (CHD) has changed in the past 50 years as a result of an increase in the prevalence and survival rate of CHD. In particular, mortality in patients with CHD has changed dramatically since the latter half of the twentieth century as a result of more timely diagnosis and the development of interventions for CHD that have prolonged life. As patients with CHD age, the disease burden shifts away from the heart and towards acquired cardiovascular and systemic complications. The societal costs of CHD are high, not just in terms of health-care utilization but also with regards to quality of life. Lifespan disease trajectories for populations with a high disease burden that is measured over prolonged time periods are becoming increasingly important to define long-term outcomes that can be improved. Quality improvement initiatives, including advanced physician training for adult CHD in the past 10 years, have begun to improve disease outcomes. As we seek to transform lifespan into healthspan, research efforts need to incorporate big data to allow high-value, patient-centred and artificial intelligence-enabled delivery of care. Such efforts will facilitate improved access to health care in remote areas and inform the horizontal integration of services needed to manage CHD for the prolonged duration of survival among adult patients.
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4
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Pardhan S, Mandalenakis Z, Giang KW, Fedchenko M, Eriksson P, Dellborg M. Healthcare consumption in congenital heart disease: A temporal life-course perspective following pediatric cases to adulthood. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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5
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Van Bulck L, Goossens E, Morin L, Luyckx K, Ombelet F, Willems R, Budts W, De Groote K, De Backer J, Annemans L, Moniotte S, de Hosson M, Marelli A, Moons P. Last year of life of adults with congenital heart diseases: causes of death and patterns of care. Eur Heart J 2022; 43:4483-4492. [PMID: 36030410 PMCID: PMC9637423 DOI: 10.1093/eurheartj/ehac484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Although life expectancy in adults with congenital heart diseases (CHD) has increased dramatically over the past five decades, still a substantial number of patients dies prematurely. To gain understanding in the trajectories of dying in adults with CHD, the last year of life warrants further investigation. Therefore, our study aimed to (i) define the causes of death and (ii) describe the patterns of healthcare utilization in the last year of life of adults with CHD. METHODS AND RESULTS This retrospective mortality follow-back study used healthcare claims and clinical data from BELCODAC, which includes patients with CHD from Belgium. Healthcare utilization comprises cardiovascular procedures, CHD physician contacts, general practitioner visits, hospitalizations, emergency department (ED) visits, intensive care unit (ICU) admissions, and specialist palliative care, and was identified using nomenclature codes. Of the 390 included patients, almost half of the study population (45%) died from a cardiovascular cause. In the last year of life, 87% of patients were hospitalized, 78% of patients had an ED visit, and 19% of patients had an ICU admission. Specialist palliative care was provided to 17% of patients, and to only 4% when looking at the patients with cardiovascular causes of death. CONCLUSIONS There is a high use of intensive and potentially avoidable care at the end of life. This may imply that end-of-life care provision can be improved. Future studies should further examine end-of-life care provision in the light of patient's needs and preferences, and how the healthcare system can adequately respond.
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Affiliation(s)
- Liesbet Van Bulck
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Research Foundation Flanders (FWO), 1000, Brussels, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, 2000, Antwerp, Belgium
| | - Lucas Morin
- Inserm CIC 1431, University Hospital of Besançon, 25000, Besançon, France,Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, 94800, Villejuif, France
| | - Koen Luyckx
- Department of Psychology and Educational Sciences, KU Leuven – University of Leuven, 3000, Leuven, Belgium,Unit for Professional Training and Service in the Behavioural Sciences (UNIBS), University of the Free State, 9300, Bloemfontein, South Africa
| | - Fouke Ombelet
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Division of Neurology, University Hospitals Leuven, 3000, Leuven, Belgium,Lab of Neurology, VIB – KU Leuven Centre for Brain and Disease Research, 3000, Leuven, Belgium
| | - Ruben Willems
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, 3000, Leuven, Belgium,Department of Cardiovascular Sciences, KU Leuven – University of Leuven, 3000, Leuven, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Julie De Backer
- Department of Adult Congenital Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Stéphane Moniotte
- Division of Pediatric and Congenital Cardiology, Department of Paediatrics, Cliniques universitaires Saint-Luc, 1000, Brussels, Belgium
| | - Michèle de Hosson
- Department of Adult Congenital Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Arianne Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, H3A 0G4, Montréal (Quebec), Canada
| | - Philip Moons
- Corresponding author. Tel: +32 16 37 33 15, Fax: +32 16 33 69 70,
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6
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Coats L, Chaudhry B. Ambulatory Care in Adult Congenital Heart Disease-Time for Change? J Clin Med 2022; 11:jcm11072058. [PMID: 35407666 PMCID: PMC9000074 DOI: 10.3390/jcm11072058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. METHODS A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, median ACHD AP class 2B) between 2014 and 2019 and the COVID-19 restrictions period (March 2020-July 2021). RESULTS Between 2014 and 2019, there were 575 appointments. Nonattendance was 10%; 15 patients recurrently nonattended. Eighty percent of appointments resulted in no decision other than continued review. Electrocardiograms and echocardiograms were frequent, but new findings were rare (5.1%, 4.0%). Decision-making was more common with the higher ACHD AP class and symptoms. Emergency admissions (n = 40) exceeded elective (n = 25), with over half following unremarkable clinic appointments. Distance travelled to the ACHD clinic was 14.9 km (1.6-265), resulting in 433-564 workdays lost. During COVID 19, there were 127 appointments (56% in-person, 41% telephone and 5% video). Decisions were made at 37% in-person and 19% virtual consultations. Nonattendance was 3.9%; there were eight emergency admissions. CONCLUSION The main purpose of the ACHD clinic is surveillance. Presently, the clinic does not sufficiently predict or prevent emergency hospital admissions and is costly to patient and provider. COVID-19 has enforced different methods for delivering care that require further evaluation.
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Affiliation(s)
- Louise Coats
- Adult Congenital Heart Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Correspondence:
| | - Bill Chaudhry
- Bioscience Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
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7
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Congenital heart disease: pathology, natural history, and interventions. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00011-6] [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: 11/22/2022] Open
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8
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Lachtrupp CL, Valente AM, Gurvitz M, Landzberg MJ, Brainard SB, Wu FM, Pearson DD, Taillie K, Opotowsky AR. Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification System. J Am Heart Assoc 2021; 10:e021345. [PMID: 34482709 PMCID: PMC8649495 DOI: 10.1161/jaha.120.021345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background American Heart Association and American College of Cardiology consensus guidelines introduce an adult congenital heart disease anatomic and physiological (AP) classification system. We assessed the association between AP classification and clinical outcomes. Methods and Results Data were collected for 1000 outpatients with ACHD prospectively enrolled between 2012 and 2019. AP classification was assigned based on consensus definitions. Primary outcomes were (1) all‐cause mortality and (2) a composite of all‐cause mortality or nonelective cardiovascular hospitalization. Cox regression models were developed for AP classification, each component variable, and additional clinical models. Discrimination was assessed using the Harrell C statistic. Over a median follow‐up of 2.5 years (1.4–3.9 years), the composite outcome occurred in 185 participants, including 49 deaths. Moderately or severely complex anatomic class (class II/III) and severe physiological stage (stage D) had increased risk of the composite outcome (AP class IID and IIID hazard ratio, 4.46 and 3.73, respectively, versus IIC). AP classification discriminated moderately between patients who did and did not suffer the composite outcome (C statistic, 0.69 [95% CI, 0.67–0.71]), similar to New York Heart Association functional class and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide); it was more strongly associated with mortality (C statistic, 0.81 [95% CI, 0.78–0.84]), as were NT‐proBNP and functional class. A model with AP class and NT‐proBNP provided the strongest discrimination for the composite outcome (C statistic, 0.73 [95% CI, 0.71–0.75]) and mortality (C statistic, 0.85 [95% CI, 0.82–0.88]). Conclusions The addition of physiological stage modestly improves the discriminative ability of a purely anatomic classification, but simpler approaches offer equivalent prognostic information. The AP system may be improved by addition of key variables, such as circulating biomarkers, and by avoiding categorization of continuous variables.
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Affiliation(s)
- Cara L Lachtrupp
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Anne Marie Valente
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA
| | - Michelle Gurvitz
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA
| | - Michael J Landzberg
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA
| | | | - Fred M Wu
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA
| | | | - Keith Taillie
- Department of Cardiology Boston Children's Hospital Boston MA
| | - Alexander R Opotowsky
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA.,Department of Medicine Brigham and Women's Hospital Boston MA.,Department of Pediatrics Heart Institute Cincinnati Children's HospitalUniversity of Cincinnati College of Medicine Cincinnati OH
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9
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Tsang W, Silversides CK, Rashid M, Roche SL, Alonso-Gonzalez R, Austin PC, Lee DS. Outcomes and healthcare resource utilization in adult congenital heart disease patients with heart failure. ESC Heart Fail 2021; 8:4139-4151. [PMID: 34402222 PMCID: PMC8497229 DOI: 10.1002/ehf2.13529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/11/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS While heart failure (HF) is a leading cause of death in adults with congenital heart disease (ACHD), few studies report contemporary outcomes after the first HF hospitalization. We examined outcomes of ACHD patients newly admitted for HF compared with ACHD patients without HF and the general HF population without ACHD. METHODS AND RESULTS Using population databases from a single-payer health system from 1994 to 2018, ACHD patients newly admitted for HF were matched 1:1 to ACHD patients without HF (n = 4030 matched pairs). Similarly, ACHD patients newly admitted for HF were matched 1:1 to HF patients without ACHD (n = 4336 matched pairs). Patients with ACHD and HF (median age 68 years, 45% women) experienced higher mortality in short-term [30 day adjusted hazard ratio (HR) 4.68, 95% confidence interval (CI) 4.06, 5.43, P < 0.001], near-term (1 year HR 3.87, 95% CI 3.77, 4.92, P < 0.001), and long-term (24 year HR 1.59, 95% CI 1.13, 2.36, P = 0.008) follow-up. Patients with ACHD and HF had fewer baseline cardiovascular comorbidities than non-ACHD HF but demonstrated higher 30 day (HR 1.56, 95% CI 1.41, 1.73, P < 0.001), 1 year (HR 1.30, 95% CI 1.20, 1.40, P < 0.001), and 24 year (HR 2.40, 95% CI 1.73, 3.38, P < 0.001) mortality. Those with ACHD and HF also exhibited higher cardiovascular readmission rates at 30 days with HRs 9.15 (95% CI; 8.00, 10.48, P < 0.001) vs. ACHD without HF, and 1.71 (95% CI; 1.54, 1.85, P < 0.001) vs. HF without ACHD, and the higher readmission risk extended to 10 year follow-up. CONCLUSIONS Adults with congenital heart disease patients with new HF have high risks of death and cardiovascular hospitalization, and preventative strategies to improve outcomes are urgently needed.
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Affiliation(s)
- Wendy Tsang
- Division of Cardiology, Toronto General Hospital, University Health Network, Peter Munk Cardiovascular Center, University of Toronto, Toronto, Ontario, Canada
| | - Candice K Silversides
- Division of Cardiology, Toronto General Hospital, University Health Network, Peter Munk Cardiovascular Center, University of Toronto, Toronto, Ontario, Canada.,Toronto Adult Congenital Heart Disease Program, Toronto, Ontario, Canada
| | - Mohammed Rashid
- ICES (formerly the Institute for Clinical Evaluative Sciences), 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - S Lucy Roche
- Division of Cardiology, Toronto General Hospital, University Health Network, Peter Munk Cardiovascular Center, University of Toronto, Toronto, Ontario, Canada.,Toronto Adult Congenital Heart Disease Program, Toronto, Ontario, Canada
| | - Rafael Alonso-Gonzalez
- Division of Cardiology, Toronto General Hospital, University Health Network, Peter Munk Cardiovascular Center, University of Toronto, Toronto, Ontario, Canada.,Toronto Adult Congenital Heart Disease Program, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES (formerly the Institute for Clinical Evaluative Sciences), 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Douglas S Lee
- Division of Cardiology, Toronto General Hospital, University Health Network, Peter Munk Cardiovascular Center, University of Toronto, Toronto, Ontario, Canada.,ICES (formerly the Institute for Clinical Evaluative Sciences), 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.,Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
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10
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Willems R, Ombelet F, Goossens E, De Groote K, Budts W, Moniotte S, de Hosson M, Van Bulck L, Marelli A, Moons P, De Backer J, Annemans L. Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:951-960. [PMID: 33835328 DOI: 10.1007/s10198-021-01300-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
AIM To scrutinize the economic impact of different care levels, such as shared care, in the follow-up of adult congenital heart disease (ACHD) patients. METHODS The BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC) was analyzed. Patients (N = 6579) were categorized into five care levels based on their cardiac follow-up pattern between 2006 and 2010. Medical costs, hospitalizations, and emergency department visits were measured between 2011 and 2015. RESULTS In patients with moderate lesions, highly specialized cardiac care (HSC; exclusive follow-up by ACHD specialists) and shared care with predominantly specialized cardiac care (SC+) were associated with significantly lower medical costs and resource use compared to shared care with predominantly general cardiac care (SC-) and general cardiac care (GCC). In the patient population with mild lesions, HSC was associated with better economic outcomes than SC- and GCC, but SC+ was not. HSC was associated with fewer hospitalizations (- 33%) and less pharmaceutical costs (- 46.3%) compared to SC+. Patients with mild and moderate lesions in the no cardiac care (NCC) group had better economic outcomes than those in the GCC and SC- groups, but post-hoc analysis revealed that they had a different patient profile than patients under cardiac care. CONCLUSION More specialized care levels are associated with better economic outcomes in patients with mild or moderate lesions in cardiac follow-up. Shared care with strong involvement of ACHD specialists might be a management option to consider. Characteristics of patients without cardiac follow-up but good medium-term economic prospects should be further scrutinized.
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Affiliation(s)
- Ruben Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42, Floor 4, 9000, Ghent, Belgium.
| | - Fouke Ombelet
- KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium
- Division of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Werner Budts
- KU Leuven Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stéphane Moniotte
- Pediatric and Congenital Cardiology Division, St-Luc University Hospital, Brussels, Belgium
| | - Michèle de Hosson
- Department of Adult Congenital Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, QC, Canada
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium
- University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Julie De Backer
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Adult Congenital Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42, Floor 4, 9000, Ghent, Belgium
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11
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Van Bulck L, Goossens E, Apers S, Moons P, Luyckx K. Illness identity in adults with congenital heart disease: Longitudinal trajectories and associations with patient-reported outcomes and healthcare use. J Adv Nurs 2021; 77:4743-4754. [PMID: 34240484 DOI: 10.1111/jan.14949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 01/19/2023]
Abstract
AIMS The aims of this study were to investigate the development of illness identity, the degree to which the disease is integrated into one's identity, by identifying trajectory classes in adults with congenital heart disease (CHD) and to describe these classes in terms of age, sex, disease complexity, patient-reported outcomes (PROs) and healthcare use. DESIGN This three-wave observational cohort study was carried from 2013 till 2015 and includes 276 adults (median age: 34 years; 54% men) with CHD. METHODS Illness identity entails four dimensions: engulfment, rejection, acceptance and enrichment. PROs included perceived health status, quality of life and psychological distress. Latent class growth analysis, analysis of variance, Poisson regression and negative binomial regression analyses were performed. RESULTS Illness identity was relatively stable over time. The identified classes were meaningfully different in terms of age, disease complexity, PROs and healthcare use. Patients who did not reject their disease, patients who were not overwhelmed or patients who accepted their disease over time reported better health status and quality of life and less psychological distress. Less hospitalizations and visits to the general practitioner and medical specialist were reported by patients who were not overwhelmed or patients who accepted their disease over time. Patients with low rejection and high enrichment scores over time reported more visits at the general practitioner. CONCLUSION These findings indicate that illness identity should be taken into account when trying to understand and optimize PROs and healthcare use of adults with CHD. IMPACT This study scrutinizes the development and clinical meaningfulness of illness identity measured over time for adults with CHD. Illness identity was found to be stable over time. Moreover, the illness identity trajectories differed in terms of PROs and healthcare use, showing that measuring and intervening upon illness identity could be a potential pathway to optimize PROs and healthcare use.
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Affiliation(s)
- Liesbet Van Bulck
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
| | - Silke Apers
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Koen Luyckx
- Department of School Psychology and Development in Context, KU Leuven - University of Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
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12
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Benderly M, Buber J, Kalter-Leibovici O, Blieden L, Dadashev A, Lorber A, Nir A, Yalonetsky S, Chodick G, Weitzman D, Balicer R, Mazor Dray E, Murad H, Razon Y, Hirsch R. Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population-Based Study. J Am Heart Assoc 2021; 10:e018037. [PMID: 33432841 PMCID: PMC7955316 DOI: 10.1161/jaha.120.018037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. Methods and Results We identified 11 653 patients with ACHD aged ≥18 years (median, 47 years), through electronic records of 2 large Israeli healthcare providers (2007–2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standardized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47–1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69–5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82–7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61–16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: primary care (HR, 1.14; 95% CI, 1.06–1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24–1.59); emergency department visits (HR, 1.19; 95% CI, 1.02–1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49–2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84–0.94]) and periphery (HR, 0.72 [95% CI, 0.58–0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. Conclusions Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and ethnicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.
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Affiliation(s)
- Michal Benderly
- Cardiovascular Epidemiology Unit Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Center Ramat-Gan Israel.,Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Jonathan Buber
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel.,Division of Cardiology Department of Medicine University of Washington School of Medicine Seattle WA
| | - Ofra Kalter-Leibovici
- Cardiovascular Epidemiology Unit Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Center Ramat-Gan Israel.,Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Leonard Blieden
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel.,Adult Congenital Heart Disease Unit Rabin Medical Center Petach Tikva Israel
| | - Alexander Dadashev
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel.,Adult Congenital Heart Disease Unit Rabin Medical Center Petach Tikva Israel
| | - Avraham Lorber
- Pediatric Cardiology and GUCH Unit Rambam Health Care CampusTechnion Faculty of Medicine Haifa Israel
| | - Amiram Nir
- Pediatric Cardiology and Adult Congenital Heart Disease Unit Shaare Zedek Medical Center Jerusalem Israel
| | - Sergei Yalonetsky
- Pediatric Cardiology and GUCH Unit Rambam Health Care CampusTechnion Faculty of Medicine Haifa Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel.,Medical Division Maccabi Healthcare Services Tel Aviv Israel
| | - Dahlia Weitzman
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel.,Medical Division Maccabi Healthcare Services Tel Aviv Israel
| | - Ran Balicer
- Clalit Research Institute Clalit Health Services Tel Aviv Israel
| | - Efrat Mazor Dray
- Faculty of Health Sciences Ben-Gurion University of the Negev Negev Israel.,Leviev Heart Institute Sheba Medical Center Ramat-Gan Israel
| | - Havi Murad
- Biostatistics Unit Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Center Ramat-Gan Israel
| | - Yaron Razon
- Faculty of Health Sciences Ben-Gurion University of the Negev Negev Israel.,Department of Pediatrics Assuta Ashdod Medical Center Ashdod Israel
| | - Rafael Hirsch
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel.,Adult Congenital Heart Disease Unit Rabin Medical Center Petach Tikva Israel
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13
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Characteristics of Patients With Congenital Heart Disease Requiring ICU Admission From Japanese Emergency Departments. Pediatr Crit Care Med 2020; 21:e1106-e1112. [PMID: 32769701 DOI: 10.1097/pcc.0000000000002440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the characteristics of patients with congenital heart disease requiring ICU admission from emergency departments and determine the associations between the reasons for emergency department visits and specific congenital heart disease types or cardiac procedures. DESIGN Retrospective observational study using data from a Japanese multicenter database. SETTING Twelve PICUs and 11 general ICUs in Japan. PATIENTS All patients requiring ICU admission from an emergency department during 2013-2018, divided into two groups: with congenital heart disease and without congenital heart disease groups. INTERVENTIONS None for this analysis. MEASUREMENTS AND MAIN RESULTS Of the 297 patients with congenital heart disease (9.2% of a total of 3,240 patients), more than half had moderate-to-high complexity congenital heart disease; most of them were pediatric patients who had visited specialized congenital heart disease centers. All the patients' clinical outcomes were similar. Regarding the reasons for emergency department admission, seizure was significantly associated with a single ventricle anatomy (odds ratio, 3.3; 95% CI, 1.1-10.0), post-Glenn shunt placement (odds ratio, 5.6; 95% CI, 1.1-29.4), and a Fontan-type operation status (odds ratio, 6.3; 95% CI, 1.5-25.5). Sepsis and gastrointestinal bleeding were associated with asplenia (odds ratio, 21.1; 95% CI, 4.3-104 and odds ratio, 21.0; 95% CI, 3.1-141, respectively); gastrointestinal bleeding was also associated with systemic-to-pulmonary artery shunt placement (odds ratio, 18.8; 95% CI, 2.8-125) and a Fontan-type operation status (odds ratio, 17.0; 95% CI, 2.6-112). Arrhythmia was associated with a single ventricle anatomy (odds ratio, 21.0; 95% CI, 3.1-141), systemic-to-pulmonary artery shunt placement (odds ratio, 18.8; 95% CI, 2.8-125), and a Fontan-type operation status (odds ratio, 17.0; 95% CI, 2.6-112). CONCLUSIONS Classification of the reasons for emergency department admission by congenital heart disease type and surgical stage may guide clinicians in the selection of appropriate treatments in such settings.
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14
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Lachtrupp CL, Valente AM, Gurvitz M, Landzberg MJ, Brainard SB, Opotowsky AR. Interobserver agreement of the anatomic and physiological classification system for adult congenital heart disease. Am Heart J 2020; 229:92-99. [PMID: 32947058 DOI: 10.1016/j.ahj.2020.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023]
Abstract
The Anatomic and Physiological (AP) classification system proposed in the 2018 American College of Cardiology/American Heart Association adult congenital heart disease (ACHD) guidelines assigns 2 dimensions to each patient: anatomic class (AnatC) and physiological stage (PhyS). This approach has not been tested in practice; we assessed interrater reliability and identified sources of disagreement. METHODS Consensus definitions for AP categories were developed with input from 4 experts. Research assistants (RAs) assigned AnatC/PhyS for patients in the Boston ACHD Biobank, a prospectively enrolled cohort of ambulatory ACHD patients ≥18 years old seen between 2012 and 2019. Two (of 4) expert reviewers then independently assigned AnatC/PhyS for 41 patients. Interrater reliability was assessed with linearly weighted kappa (κω) for agreement between (1) experts and (2) an RA and an expert. Experts examined disagreements and identified sources of variability and areas requiring clarification. RESULTS Interexpert agreement for AnatC was excellent, with agreement on 38/41 (92.7%) cases and κω 0.88 [0.75, 1.01]. Agreement for PhyS was less robust, with consensus on 24/41 cases (59.5%), κω 0.57 [0.39, 0.75]. Expert-RA agreement was lower for AnatC (κω 0.77 [0.60, 0.95]), whereas PhyS was similar to interexpert agreement (κω 0.53 [0.34, 0.72]). There was ambiguity in the definitions of (1) arrhythmia status, (2) cyanotic CHD, and (3) valve disease. CONCLUSIONS Although AnatC can be assessed reliably, that is not true for the PhyS part of the AP classification proposed in the 2018 American College of Cardiology/American Heart Association guidelines. Reliability of PhyS would be strengthened by more precise definitions readily interpretable in clinical practice.
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Affiliation(s)
- Cara L Lachtrupp
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael J Landzberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sarah B Brainard
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Alexander R Opotowsky
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA; The Heart Institute, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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15
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Woudstra OI, Kuijpers JM, Jongbloed MRM, van Dijk APJ, Sieswerda GT, Vliegen HW, Egorova AD, Kiès P, Duijnhouwer AL, Robbers-Visser D, Konings TC, Zwinderman AH, Meijboom FJ, Mulder BJM, Bouma BJ. Medication in adults after atrial switch for transposition of the great arteries: clinical practice and recommendations. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 8:77-84. [PMID: 32976560 PMCID: PMC8728040 DOI: 10.1093/ehjcvp/pvaa111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/27/2020] [Accepted: 09/11/2020] [Indexed: 01/14/2023]
Abstract
Abstract
Aims
Heart failure is the main threat to long-term health in adults with transposition of the great arteries (TGA) corrected by an atrial switch operation (AtrSO). Current guidelines refrain from recommending heart failure medication in TGA-AtrSO, as there is insufficient data to support the hypothesis that it is beneficial. Medication is therefore prescribed based on personal judgements. We aimed to evaluate medication use in TGA-AtrSO patients and examine the association of use of renin–angiotensin–aldosterone system (RAAS) inhibitors and β-blockers with long-term survival.
Methods and results
We identified 150 TGA-AtrSO patients [median age 30 years (interquartile range 25–35), 63% male] included in the CONCOR registry from five tertiary medical centres with subsequent linkage to the Dutch Dispensed Drug Register for the years 2006–2014. Use of RAAS inhibitors, β-blockers, and diuretics increased with age, from, respectively, 21% [95% confidence interval (CI) 14–40], 12% (95% CI 7–21), and 3% (95% CI 2–7) at age 25, to 49% (95% CI 38–60), 51% (95% CI 38–63), and 41% (95% CI 29–54) at age 45. Time-varying Cox marginal structural models that adjusted for confounding medication showed a lower mortality risk with use of RAAS inhibitors and β-blockers in symptomatic patients [hazard ratio (HR) = 0.13 (95% CI 0.03–0.73); P = 0.020 and HR = 0.12 (95% CI 0.02–0.17); P = 0.019, respectively]. However, in the overall cohort, no benefit of RAAS inhibitors and β-blockers was seen [HR = 0.93 (95% CI 0.24–3.63); P = 0.92 and HR = 0.98 (0.23–4.17); P = 0.98, respectively].
Conclusion
The use of heart failure medication is high in TGA-AtrSO patients, although evidence of its benefit is limited. This study showed lower risk of mortality with use of RAAS inhibitors and β-blockers in symptomatic patients only. These findings can direct future guidelines, supporting use of RAAS inhibitors and β-blockers in symptomatic, but not asymptomatic patients.
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Affiliation(s)
| | - Joey M Kuijpers
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Gertjan T Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Hubert W Vliegen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Anastasia D Egorova
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Anthonie L Duijnhouwer
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Daniëlle Robbers-Visser
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Thelma C Konings
- Department of Cardiology, Amsterdam UMC, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Barbara J M Mulder
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Berto J Bouma
- Corresponding author. Tel: +31 020 566 9111, Fax: +31 020 696 2609,
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16
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Ntiloudi D, Dimopoulos K, Tzifa A, Karvounis H, Giannakoulas G. Hospitalizations in adult patients with congenital heart disease: an emerging challenge. Heart Fail Rev 2020; 26:347-353. [PMID: 32914242 DOI: 10.1007/s10741-020-10026-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
The vast majority of patients with congenital heart disease (CHD) survive into adulthood, but many face lifelong complications, which often result in a hospital admission. The increasing number of hospitalizations in adults with CHD (ACHD) poses a significant challenge for healthcare systems globally, especially as heart failure (HF) is becoming increasingly common in this population and is the leading cause of morbidity and mortality. Besides HF, other major contributors to this increase in admission volume are hospitalizations related to mild lesions, comorbidities and pregnancies. Ιn-hospital mortality ranges between 0.8 and 6.1%, while hospitalizations related to HF predict medium-term mortality in ACHD population. Understanding the predictors of hospitalization and in-hospital mortality is, therefore, important for ACHD healthcare providers, who should identify patients at risk that require escalation of treatment and/or close monitoring. This article reviews the available literature on hospitalization patterns in ACHD patients, with a focus on HF-related hospital admissions and specific diagnostic subgroups.
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Affiliation(s)
- Despoina Ntiloudi
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kyriakidi str 1, 546 36, Thessaloniki, Greece
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Aphrodite Tzifa
- Department of Congenital Cardiology and Cardiac Surgery, Mitera Hospital, Athens, Greece.,Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Haralambos Karvounis
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kyriakidi str 1, 546 36, Thessaloniki, Greece
| | - George Giannakoulas
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kyriakidi str 1, 546 36, Thessaloniki, Greece.
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17
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Van Bulck L, Goossens E, Luyckx K, Apers S, Oechslin E, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Moons P. Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries. BMC Health Serv Res 2020; 20:496. [PMID: 32493367 PMCID: PMC7268498 DOI: 10.1186/s12913-020-05361-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease. METHODS This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. RESULTS Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed. CONCLUSIONS This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn. TRIAL REGISTRATION ClinicalTrials.gov: NCT02150603. Registered 30 May 2014.
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Affiliation(s)
- Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,Division of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven - University of Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Silke Apers
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Erwin Oechslin
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital - Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,KU Leuven Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan
| | - Maayke A Sluman
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Chun-Wei Lu
- National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Msida, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France
| | - Susan M Fernandes
- Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, CA, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, NE, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium. .,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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18
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Geenen LW, Baggen VJM, van den Bosch AE, Eindhoven JA, Kauling RM, Cuypers JAAE, Roos-Hesselink JW, Boersma E. Prognostic Value of Serial High-Sensitivity Troponin T Measurements in Adults With Congenital Heart Disease. Can J Cardiol 2020; 36:1516-1524. [PMID: 32297863 DOI: 10.1016/j.cjca.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Single high-sensitivity troponin T (hs-TnT) measurement is predictive of cardiac events in adults with congenital heart disease (ACHD). We aimed to study the prognostic value of serial hs-TnT measurements in stable patients with ACHD. METHODS In total, 602 consecutive patients with ACHD were enrolled in this prospective study (2011-2013). Blood sampling was performed at enrollment and thereafter yearly during scheduled visits, up to 4 years. Hs-TnT, N-terminal pro B-type natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR) were measured. The composite primary endpoint was defined as all-cause mortality, heart failure, arrhythmia, hospitalization, cardiac (re)interventions, or thromboembolic events. The relationship between changes in serial hs-TnT and the primary endpoint was studied by joint models with adjustment for repeated NT-proBNP and eGFR. RESULTS In 601 patients (median age, 33 [interquartile range, 25-41] years, 42% women, 90% NYHA I), at least 1 hs-TnT measurement was performed; a mean of 4.3 hs-TnT measurements per patient were collected. After a median follow-up of 5.8 [interquartile range, 5.3-6.3] years, 229 (38.1%) patients reached the primary endpoint. On average, hs-TnT levels increased over time, and more in patients who reached the primary endpoint (P < 0.001). A 2-fold higher hs-TnT was associated with the primary endpoint (unadjusted hazard ratio, 1.62; 95% confidence interval, 1.44-1.82; P < 0.001). The association remained after adjustment for repeated eGFR but not when adjusted for repeated NT-proBNP; repeated NT-proBNP remained associated with the primary endpoint. CONCLUSION In stable patients with ACHD, hs-TnT levels increased before the occurrence of an event and repeated hs-TnT was associated with the risk of adverse cardiac events. However, repeated hs-TnT was not superior to repeated NT-proBNP.
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Affiliation(s)
- Laurie W Geenen
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Vivan J M Baggen
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | | | - Jannet A Eindhoven
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Robert M Kauling
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands; Department of Clinical Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Martínez-Quintana E, Girolimetti A, Jiménez-Rodríguez S, Fraguela-Medina C, Rodríguez-González F, Tugores A. Prevalence and predictors of psychological distress in congenital heart disease patients. J Clin Psychol 2020; 76:1705-1718. [PMID: 32149405 DOI: 10.1002/jclp.22948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine psychological distress in congenital heart disease (CHD) patients. METHODS Cross-sectional study among consecutive CHD patients recruited from a single hospital outpatient clinic to determine anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS) questionnaire. RESULTS One hundred and sixty-nine CHD patients [29 (19-39) years old, 100 (59%) males] were studied. A total of 25% and 9% of CHD patients showed anxiety and depression symptoms, respectively. Patients with an HADS score ≥ 8 had a significantly worse New York Heart Association (NYHA) functional class, needed more psychological support, had more mental health history, and took more anxiolytic/antidepressant medication than the CHD patients with an HADS score below 8. A worse NYHA functional class [OR, 1.88 (1.01-3.52)] proved to be a predictor of a borderline/abnormal HADS score. CONCLUSION Psychological distress has a high prevalence among CHD patients and having an NYHA Class II and III is a significant predictor of an HADS score ≥ 8.
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Affiliation(s)
- Efrén Martínez-Quintana
- Cardiology Service, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.,Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Angela Girolimetti
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sara Jiménez-Rodríguez
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carla Fraguela-Medina
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Fayna Rodríguez-González
- Ophthalmology Service, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Antonio Tugores
- Research Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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Opinions of general and adult congenital heart disease cardiologists on care for adults with congenital heart disease in Belgium: a qualitative study. Cardiol Young 2019; 29:1368-1374. [PMID: 31489832 DOI: 10.1017/s1047951119002245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The growing adult congenital heart disease (CHD) population requires efficient healthcare organisation. It has been suggested that clinically appropriate care be provided for individual patients on the least complex level possible, in order to alleviate saturation of special care programmes. METHODS Semi-structured interviews with 10 general and 10 adult CHD cardiologists were conducted to elucidate opinions on healthcare organisation in Belgium. A particular focus was placed on the potential role of general cardiologists. The software program NVivo 12 facilitated thematic analysis. RESULTS A discrepancy existed between how general cardiologists thought about congenital care and what adult CHD cardiologists considered the minimum knowledge required to adequately treat patients. Qualitative data were categorised under the following themes: knowledge dissemination, certification, (de)centralisation of care, the role of adult CHD cardiologists, the role of dedicated nurse specialists, and patient referral. It appeared to be pivotal to organise care in such a way that providing basic care locally does not impede the generation of sufficient patient volume, and to continue improving communications between different care levels when there is no referral back. Moreover, practical knowledge is best disseminated locally. Cardiologists' opinions on certification and on the role of dedicated nurse specialists were mixed. CONCLUSION On the basis of the results, we propose five recommendations for improving the provision of care to adults with CHD. A multidimensional approach to defining the role of different healthcare professionals, to improving communication channels, and to effectively sensitising healthcare professionals is needed to improve the organisation of care.
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Healthcare utilisation in migrant children with CHDs in China. Cardiol Young 2019; 29:1320-1321. [PMID: 31513004 DOI: 10.1017/s1047951119002208] [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: 11/06/2022]
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