Association of Adults With Congenital Heart Disease-Specific Care With Clinical Characteristics and Healthcare Use

Adult congenital heart disease care in a municipal public health system

Specialty care is associated with improved outcomes for adults with adult CHD and must be extended to the underserved. A retrospective cohort study was performed to describe the provision of care to adult CHD patients in America's largest municipal public health system including patient demographics, diagnostic and therapeutic procedures, and adherence to guideline-recommended surveillance. We identified 229 adult CHD patients aged >18 years through electronic medical records. The most common diagnoses were atrial septal defect, ventricular septal defect, patent ductus arteriosus, and valvular pulmonary stenosis. In total, 65% had moderate or greater anatomic complexity. A large number of patients were uninsured (45%), non-white (96%), and non-English speaking (44%). One hundred forty-six patients (64%) presented with unrepaired primary defects. Fifty eight patients underwent primary repair during the study period; 48 of those repairs were surgical and 10 were transcatheter. Collaboration with an affiliated Comprehensive Care Center was utilised for 28% of patients. A high proportion of patients received adult CHD speciality visits (78%), echocardiograms (66%), and electrocardiograms (56%) at the guideline-recommended frequency throughout the study period. There was no significant difference in the rate of adherence to guideline-recommended surveillance based on insurance status, race/ethnicity, or primary language status. The proportion of patients who had guideline-recommended adult CHD visits, echocardiograms, and electrocardiograms was significantly lower for those with more advanced physiological stages. These results can inform the provision of adult CHD care in other public health system settings.

Factors Associated With Nonattendance at the Adult Congenital Heart Disease Clinic

Adults with congenital heart disease (CHD) are a complex population for whom adult CHD-specific care results in better outcomes. Our objective was to identify factors associated with no-shows and cancelations in an adult CHD (ACHD) clinic and evaluate the efficacy of a social worker intervention to promote ambulatory follow-up. The medical record identified adults with a scheduled appointment in the adult CHD clinic from January 2017 to March 2021. Social worker intervention was performed between March 2020 and May 2021 and consisted of phone calls to those who did not show up. Logistic regression and descriptive statistics were performed. Of 8,431 scheduled visits, 56.7% were completed, 4.6% were no-shows, and 17.5% were canceled by patients. The factors associated with no-shows were Medicaid (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.26 to 2.12, p <0.001), previous no-show (OR per 1% increase in previous no-show rate 1.13, 95% CI 1.12 to 1.15, p <0.001), satellite clinic location (OR 3.15, 95% CI 2.06 to 4.74, p <0.001), virtual visit (OR 1.97, 95% CI 1.28 to 2.92, p = 0.001), and Hispanic ethnicity (OR 1.48, 95% CI 1.03 to 2.10, p = 0.031). The factors associated with cancelations were female gender (OR 1.45, 95% CI 1.25 to 1.68, p <0.001) and virtual visits (OR 2.24, 95% CI 1.50 to 3.40, p <0.001). Social worker outreach calls did not impact frequency of rescheduling. No patients accepted additional support. In conclusion, Medicaid insurance, previous number of no-shows, and Hispanic ethnicity were found to be associated with a higher risk of no-show, identifying a high-risk population that may benefit from targeted interventions. Social worker outreach did not have an appreciable impact on the rescheduling rates.