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Lindor RA, Heller K, Hodgson NR, Kishi P, Monas J, Rappaport D, Thomas A, Urumov A, Walker LE, Majdalany DS. Adult Congenital Heart Disease in the Emergency Department. J Pers Med 2024; 14:66. [PMID: 38248767 PMCID: PMC10817528 DOI: 10.3390/jpm14010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/18/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
While congenital heart disease historically was a pathology primarily restricted to specialized pediatric centers, advances in technology have dramatically increased the number of people living into adulthood, the number of complications faced by these patients, and the number of patients visiting non-specialized emergency departments for these concerns. Clinicians need to be aware of the issues specific to patients' individual congenital defects but also have an understanding of how typical cardiac pathology may manifest in this special group of patients. This manuscript attempts to provide an overview of this diverse but increasingly common group of adult patients with congenital heart diseases, including a review of their anatomical variants, the complications they face at the highest rates, and ways that emergency physicians may need to manage these patients differently to avoid causing harm.
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Affiliation(s)
- Rachel A. Lindor
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Kim Heller
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Nicole R. Hodgson
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Patrick Kishi
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Jessica Monas
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Douglas Rappaport
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Aaron Thomas
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Andrej Urumov
- Mayo Clinic Department of Emergency Medicine, Phoenix, AZ 85054, USA
| | - Laura E. Walker
- Mayo Clinic Department of Emergency Medicine, Rochester, MN 55905, USA
| | - David S. Majdalany
- Mayo Clinic Department of Cardiovascular Diseases, Phoenix, AZ 85054, USA;
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Kuraoka A, Ishizu T, Nakai M, Sumita Y, Kawamatsu N, Machino-Ohtsuka T, Masuda K, Ieda M. Trends in Unplanned Admissions of Patients With Adult Congenital Heart Disease Based on the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination Study. Circ J 2023; 88:83-89. [PMID: 37880107 DOI: 10.1253/circj.cj-23-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND The prevalence of adult congenital heart disease (ACHD) is increasing rapidly and in particular, patients who underwent complicated surgeries are reaching their youth and middle age. Therefore, the need for ACHD treatment will increase, but the current medical situation is unknown. In this study we assessed trends in unplanned admissions in patients with ACHD in Japan.Methods and Results: From the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination, a nationwide claim-based database, we selected patients aged >15 years with CHD defined by the International Classification of Diseases, 10th Revision codes. We identified 39,676 admissions between April 2012 and March 2018; 10,444 (26.3%) were unplanned. Main diagnoses were categorized into 3 degrees of complexity (severe, moderate, and mild) and other. Among unplanned admissions, the proportion of the severe group increased with time. Patients in the mild group were significantly older than those in the moderate and severe groups (median age: 70.0, 39.0, and 32.0 years, respectively). There were 765 deaths during hospitalization (overall mortality rate, 7.3%). The odds ratio of death during admission was significantly higher in patients aged >50 years, especially in the moderate group. CONCLUSIONS Patients with moderate or severe ACHD tended to experience unplanned admissions at a younger age. In anticipation of greater numbers of new, severe patients, we need to prepare for their increasing medical demands.
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Affiliation(s)
- Ayako Kuraoka
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Clinical Research Support Center, University of Miyazaki Hospital
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Naoto Kawamatsu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Keita Masuda
- Department of Cardiology, St. Luke's International Hospital
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
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Diogenes MSB, Valente AS, Rocha HAL. Adult Congenital Heart Disease: Report from a Public Reference Hospital in Northeastern Brazil. Braz J Cardiovasc Surg 2023; 38:e20230039. [PMID: 37801566 PMCID: PMC10550255 DOI: 10.21470/1678-9741-2023-0039] [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: 01/30/2023] [Accepted: 04/10/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION The increasing worldwide number of adults with congenital heart disease (CHD) demands greater attention from health professionals. The purpose of this report is to describe the clinical demographic profile, frequency, and invasive treatment status of adults with CHD in a public reference hospital in northeastern Brazil. METHODS This is a retrospective cross-sectional study including 704 patients attended between August 2016 and August 2020. Data were collected from virtual database. RESULTS Patients' age varied from 17 to 81 years (mean 32±14; median 27 years); 294 (41.8%) patients were male, and 410 (58,2%) were female; 230 (32,7%) had diagnosis from age 18 and up. Cardiac complexity categories were "simple defects" (134 [19%] patients), "moderate complexity" (503 [71.5%]), and "great complexity" (67 [9.5%]). Atrial septal defect (ASD) was diagnosed in 216 (30.7%) patients, ventricular septal defect (VSD) in 101 (14.3%), tetralogy of Fallot in 93 (13.2%), and other CHD in 294 (41.8%). New York Heart Association (NYHA) functional classes were I (401 [57%]), II (203 [28.8%]), III (76 [10.8%]), and IV (24 [3.4%]). Complications were arrhythmias (173 [24%]) and severe pulmonary hypertension (69 [9.8%]). Invasive treatments were corrective surgery (364 (51.6%]), reoperation (28 [4.0%]), palliation (11 [1.6%]), interventional catheterization (12 [1.7%]), surgery plus interventional catheterization (5 [0.7%]), and preoperation (91 [12.9%]). Treatment was not required in 102 (14,5%) patients, and 91 (12.9%) were inoperable. CONCLUSION The leading diagnosis was ASD. Frequency of unrepaired patients was high, mainly ASD, due to late diagnosis, which favored complications and denotes a matter of great concern.
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Affiliation(s)
| | | | - Hermano Alexandre Lima Rocha
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza,
Ceará, Brazil
- Department of Public Health, Faculdade de Medicina, Universidade
Federal do Ceará, Fortaleza, Ceará, Brazil
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Borrelli N, Grimaldi N, Papaccioli G, Fusco F, Palma M, Sarubbi B. Telemedicine in Adult Congenital Heart Disease: Usefulness of Digital Health Technology in the Assistance of Critical Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5775. [PMID: 37239504 PMCID: PMC10218523 DOI: 10.3390/ijerph20105775] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
The number of adults with congenital heart disease (ACHD) has progressively increased in recent years to surpass that of children. This population growth has produced a new demand for health care. Moreover, the 2019 coronavirus pandemic has caused significant changes and has underlined the need for an overhaul of healthcare delivery. As a result, telemedicine has emerged as a new strategy to support a patient-based model of specialist care. In this review, we would like to highlight the background knowledge and offer an integrated care strategy for the longitudinal assistance of ACHD patients. In particular, the emphasis is on recognizing these patients as a special population with special requirements in order to deliver effective digital healthcare.
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Affiliation(s)
| | | | | | | | | | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AO Dei Colli-Monaldi Hospital, 80131 Naples, Italy
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Keir M, Borman M, Clegg R, Colbert J, Guron N, Harper L, Helmerson D, Patzer J, Reynolds S, Alvarez N. Caring for the Aging Patient With Adult Congenital Heart Disease: A Review of Cardiac and Noncardiac Comorbidities. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:274-281. [PMID: 37969485 PMCID: PMC10642149 DOI: 10.1016/j.cjcpc.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2023]
Abstract
As the demographics of congenital heart disease (CHD) have shifted, there are now more adults living with CHD than children in North America. This presents unprecedented challenges as patients with CHD acquire noncardiac comorbidities and seek care for a variety of reasons, including noncardiac surgery and emergency department (ED) visits. CHD shifts from a one organ problem to a multisystem disease and requires a team of specialists to maintain high-quality longitudinal care. In this review, we summarize the challenges patients with CHD and their providers face as they age. We review the demographics of CHD and health care utilization. We examine the rates of noncardiac comorbidities and the current quality of care received by adult patients with CHD.
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Affiliation(s)
- Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Meredith Borman
- Section of Gastroenterology, Division of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robin Clegg
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jillian Colbert
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nita Guron
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lea Harper
- Section of Respirology, Division of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Doug Helmerson
- Section of Respirology, Division of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Patzer
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Stephen Reynolds
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nanette Alvarez
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Crea F. A focus on congenital heart disease and neonatal cardiac regeneration: an exciting future. Eur Heart J 2022; 43:2643-2646. [PMID: 35858679 DOI: 10.1093/eurheartj/ehac379] [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: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Crea F. New avenues in the prevention of sudden cardiac death. Eur Heart J 2022; 43:2083-2086. [PMID: 35667660 DOI: 10.1093/eurheartj/ehac277] [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: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Crea F. Hot topics in congenital heart disease and new insight into ventricular non-compaction. Eur Heart J 2021; 42:4197-4201. [PMID: 34724708 DOI: 10.1093/eurheartj/ehab746] [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: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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