Surgical outcomes in complex adult congenital heart disease: a brief review

Healthcare Use Among Black and White Congenital Heart Disease Medicaid Enrollees

Congenital heart disease (CHD) is the most common birth anomaly in the US. Research shows lost-to-follow-up trends and racial disparities in healthcare use. This study examines racial differences in healthcare use among Medicaid-covered children with CHD. Using 2010-2019 claims data from a pediatric Medicaid Accountable Care Organization, 960 Black and White children with complex CHD and ≥ 3 years of continuous Medicaid coverage were identified. Three cohorts were constructed (starting age: < 1-year-olds, 1-5-year-olds, 6-15-year-olds) and followed for 3 years. Multivariate analysis assessed annual healthcare use (cardiology, primary care, emergency department) by race, adjusting for patient and provider covariates. Overall, 51% of patients had an annual cardiology visit, and 54% had an annual primary care visit. Among the 1-5-year-old cohort, Black children were predicted to be 13% less likely to have an annual cardiology visit compared to their White counterparts (p = 0.001). Older Black children were predicted to be more likely to have a primary care visit compared to their White counterparts. Nearly half of Medicaid-enrolled children with complex CHD did not receive recommended cardiology care. Young Black children were less likely to receive an annual cardiac visit, while older Black children were more likely to receive primary care. While the percentage with an annual cardiac visit was low, the majority had seen a cardiologist within the 3-year window, suggesting these children are still receiving cardiology care, if less frequently than recommended. Opportunities exist for cardiology and primary care to collaborate to ensure patients receive timely recommended care.

Assessment of Hypertension, Guideline-Directed Counseling, and Outcomes in the ACHD Population

Guidelines for the diagnosis and treatment of hypertension were published by the American Heart Association (AHA) in 2017. The prevalence of hypertension in adults with congenital heart disease (ACHD) under these guidelines has yet to be characterized. We sought to assess the prevalence, impact, and provider response to hypertension under current guidelines. Data were obtained retrospectively from records of routine clinic visits over a 10 year period. Potential hypertension-related adverse outcomes including stroke, myocardial infarction, surgical intervention for aortic aneurysm, aortic dissection, atrial fibrillation or flutter, cardiac transplantation and death were recorded. The 1070 patients who met inclusion criteria had a mean age of 30.8 ± 10.0 years. The prevalence of hypertension under the 2017 guidelines was 46.6%. Multivariate modeling identified cyanosis, male gender, older age, and overweight/obesity as independent risk factors for hypertension. Guideline-directed management of hypertension in ACHD patients occurred more frequently in ACHD and adult cardiology clinics than in pediatric cardiology clinics (44.1% and 45.1% vs. 24.0%, p < 0.01, respectively). Adverse outcomes were reported in 217 (20%) patients, the most prevalent of which was atrial fibrillation or flutter (11%). Multivariable modelling for any adverse outcome identified older age, hypertension, cyanosis, greater complexity ACHD, and obesity as risk factors. Modifiable risk factors for atherosclerotic cardiovascular disease are common and often under addressed in the ACHD population.

Surgical Treatment of Adults with Uncorrected Tetralogy of Fallot: A Clinical Case Series

The tetralogy of Fallot is the most common form of cyanotic congenital heart malformations. However, its association with Down syndrome is uncommon. We present two patients with uncorrected during childhood tetralogy of Fallot. One of them had also Down syndrome. We performed a complete surgical correction: closure of the inter-ventricular defect, right ventricular outflow tract reconstruction, pulmonary valve prosthesis and pulmonary artery patch repair (in one of the cases). The postoperative period was uncomplicated, patients were discharged on days 12 and 10, and the follow-up showed a significant functional class improvement.

Quality of life analysis of children with patent ductus arteriosus after closure treatment: A single-centre study

AIM

To explore the changes in quality of life (QoL) in children who underwent patent ductus arteriosus (PDA) closure and the difference in the QoL between the post-operative patients and healthy children.

METHODS

The Pediatric Quality of Life Inventory 4.0 scale was used to assess the QoL of 48 children before and after receiving PDA closure and 50 healthy children who underwent physical examination in our hospital. Relevant clinical data were collected and analysed.

RESULTS

In this study, a total of 45 patients completed the follow-up, and all the children in the control group completed the follow-up. The results showed that the patients' QoL had been improved after PDA closure, and the scores of emotional functioning and social functioning had been significantly improved compared with those in the pre-operative status. In comparing the QoL between the patient group and the control group, the results before treatment were worse than those of the control group. After treatment, the gap between the score of QoL of the patients and the healthy control group was reduced to some extent. However, in terms of social functioning, the patients' feedback was not as positive as healthy children.

CONCLUSION

For children with PDA, closure treatment can significantly improve their clinical symptoms and QoL. However, there is still a gap compared with healthy children, so health education and further intervention after treatment are still necessary.

Effect of congenital heart disease on the recurrence of cough variant asthma in children

Background

The research into the recurrence of cough variant asthma (CVA) in congenital heart disease (CHD) are few in number. The purpose of this study is to investigate the effect of CHD on the risk of the recurrence of CVA.

Methods

This study was a retrospective cohort study of 489 children with CVA aged between one and 14 years, of whom 67 had CHD complicated with CVA and 134 had CVA without CHD at a ratio of 1:2 according to age, sex and index year. The adjusted hazard ratio (aHR) of CVA recurrence in both the CHD cohort and the non-CHD cohort was determined by multivariate analysis using the Cox proportional hazard regression model.

Results

Adjusting for CHD classification, Mycoplasma pneumonia (MP) infection and immunoglobulin E (IgE) sensitization, the recurrence hazard of CVA in the complex congenital heart disease (CCHD) group (aHR = 3.281; 95% CI 1.648–6.530; P < 0.01) was significantly higher than that in the simple congenital heart disease group (aHR = 2.555; 95% CI 1.739–3.752; P < 0.01). Further, children with IgE sensitization (aHR = 2.172; 95% CI 1.482–3.184; P < 0.01) had a higher recurrence hazard of CVA than those without IgE sensitization, and children with MP infection (aHR = 1.777; 95% CI 1.188–2.657; P < 0.01) had a higher recurrence hazard of CVA than those without the MP infection.

Conclusion

The hazard of recurrent CVA is higher in children with CHD, especially in the CCHD children. In addition, those children with IgE sensitization or a MP infection had an increased hazard of recurrent CVA.