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Ivey LC, Ahmad A, Chen J, Rodriguez Iii FH, Raskind-Hood C, Book WM. Anatomic and physiologic classification of adults with congenital heart disease to predict adverse outcomes: Use of administrative codes compared to clinical staging. Am Heart J 2024; 271:12-19. [PMID: 38367894 DOI: 10.1016/j.ahj.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The 2018 anatomic physiologic (AP) classification American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for Adults with Congenital Heart Disease (ACHD) encompasses both native and post-operative anatomy and physiology to guide care management. As some physiologic conditions and post-operative states lack specific International Classification of Diseases (ICD) 9- Clinical Modification (CM) and 10-CM codes, an ICD code-based classification approximating the ACHD AP classification is needed for population-based studies. METHODS A total of 232 individuals, aged ≥ 18 years at the time of a health encounter between January 1, 2010 and December 31, 2019 and identified with at least one of 87 ICD codes for a congenital heart defect were validated through medical chart review. Individuals were assigned one of 4 mutually exclusive modified AP classification categories: (1) severe AB, (2) severe CD, (3) non-severe AB, or (4) non-severe CD, based on native anatomy "severe" or "non-severe" and physiology AB ("none" or "mild") or CD ("moderate" or "severe") by two methods: (1) medical record review, and (2) ICD and Current Procedural Terminology (CPT) code-based classification. The composite outcome was defined as a combination of a death, emergency department (ED) visits, or any hospitalizations that occurred at least 6 months after the index date and was assessed by each modified AP classification method. RESULTS Of 232 cases (52.2% male, 71.1% White), 28.4% experienced a composite outcome a median of 1.6 years after the index encounter. No difference in prediction of the composite outcome was seen based on modified AP classification between chart review and ICD code-based methodology. CONCLUSION Modified AP classification by chart review and ICD codes are comparable in predicting the composite outcome at least 6 months after classification. Modified AP classification using ICD code-based classification of CHD native anatomy and physiology is an important tool for population-based ACHD surveillance using administrative data.
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Affiliation(s)
- Lindsey C Ivey
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Attila Ahmad
- Gill Heart & Vascular Institute, Pavilion-G UK Albert B. Chandler Hospital, Department of Medicine and department of Pediatrics, Lexington, KY
| | | | | | - Cheryl Raskind-Hood
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Wendy M Book
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA; Emory University School of Medicine, Cardiology, Atlanta, GA.
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Ivey LC, Rodriguez FH, Shi H, Chong C, Chen J, Raskind‐Hood CL, Downing KF, Farr SL, Book WM. Positive Predictive Value of International Classification of Diseases, Ninth Revision, Clinical Modification, and International Classification of Diseases, Tenth Revision, Clinical Modification, Codes for Identification of Congenital Heart Defects. J Am Heart Assoc 2023; 12:e030821. [PMID: 37548168 PMCID: PMC10492959 DOI: 10.1161/jaha.123.030821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/28/2023] [Indexed: 08/08/2023]
Abstract
Background Administrative data permit analysis of large cohorts but rely on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes that may not reflect true congenital heart defects (CHDs). Methods and Results CHDs in 1497 cases with at least 1 encounter between January 1, 2010 and December 31, 2019 in 2 health care systems, identified by at least 1 of 87 ICD-9-CM/ICD-10-CM CHD codes were validated through medical record review for the presence of CHD and CHD native anatomy. Interobserver and intraobserver reliability averaged >95%. Positive predictive value (PPV) of ICD-9-CM/ICD-10-CM codes for CHD was 68.1% (1020/1497) overall, 94.6% (123/130) for cases identified in both health care systems, 95.8% (249/260) for severe codes, 52.6% (370/703) for shunt codes, 75.9% (243/320) for valve codes, 73.5% (119/162) for shunt and valve codes, and 75.0% (39/52) for "other CHD" (7 ICD-9-CM/ICD-10-CM codes). PPV for cases with >1 unique CHD code was 85.4% (503/589) versus 56.3% (498/884) for 1 CHD code. Of cases with secundum atrial septal defect ICD-9-CM/ICD-10-CM codes 745.5/Q21.1 in isolation, PPV was 30.9% (123/398). Patent foramen ovale was present in 66.2% (316/477) of false positives. True positives had younger mean age at first encounter with a CHD code than false positives (22.4 versus 26.3 years; P=0.0017). Conclusions CHD ICD-9-CM/ICD-10-CM codes have modest PPV and may not represent true CHD cases. PPV was improved by selecting certain features, but most true cases did not have these characteristics. The development of algorithms to improve accuracy may improve accuracy of electronic health records for CHD surveillance.
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Affiliation(s)
- Lindsey C. Ivey
- Division of CardiologyEmory University School of MedicineDivision of CardiologyAtlantaGAUSA
| | - Fred H. Rodriguez
- Division of CardiologyEmory University School of MedicineDivision of CardiologyAtlantaGAUSA
- Children’s Healthcare of Atlanta CardiologyAtlantaGAUSA
| | - Haoming Shi
- Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGAUSA
| | - Cohen Chong
- Emory University Rollins School of Public HealthAtlantaGAUSA
- Now with Philadelphia College of Osteopathic MedicinePhiladelphiaPAUSA
| | | | | | - Karrie F. Downing
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Wendy M. Book
- Division of CardiologyEmory University School of MedicineDivision of CardiologyAtlantaGAUSA
- Emory University Rollins School of Public HealthAtlantaGAUSA
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Downing KF, Nembhard WN, Rose CE, Andrews JG, Goudie A, Klewer SE, Oster ME, Farr SL. Survival From Birth Until Young Adulthood Among Individuals With Congenital Heart Defects: CH STRONG. Circulation 2023; 148:575-588. [PMID: 37401461 PMCID: PMC10544792 DOI: 10.1161/circulationaha.123.064400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Limited population-based information is available on long-term survival of US individuals with congenital heart defects (CHDs). Therefore, we assessed patterns in survival from birth until young adulthood (ie, 35 years of age) and associated factors among a population-based sample of US individuals with CHDs. METHODS Individuals born between 1980 and 1997 with CHDs identified in 3 US birth defect surveillance systems were linked to death records through 2015 to identify those deceased and the year of their death. Kaplan-Meier survival curves, adjusted risk ratios (aRRs) for infant mortality (ie, death during the first year of life), and Cox proportional hazard ratios for survival after the first year of life (aHRs) were used to estimate the probability of survival and associated factors. Standardized mortality ratios compared infant mortality, >1-year mortality, >10-year mortality, and >20-year mortality among individuals with CHDs with general population estimates. RESULTS Among 11 695 individuals with CHDs, the probability of survival to 35 years of age was 81.4% overall, 86.5% among those without co-occurring noncardiac anomalies, and 92.8% among those who survived the first year of life. Characteristics associated with both infant mortality and reduced survival after the first year of life, respectively, included severe CHDs (aRR=4.08; aHR=3.18), genetic syndromes (aRR=1.83; aHR=3.06) or other noncardiac anomalies (aRR=1.54; aHR=2.53), low birth weight (aRR=1.70; aHR=1.29), and Hispanic (aRR=1.27; aHR=1.42) or non-Hispanic Black (aRR=1.43; aHR=1.80) maternal race and ethnicity. Individuals with CHDs had higher infant mortality (standardized mortality ratio=10.17), >1-year mortality (standardized mortality ratio=3.29), and >10-year and >20-year mortality (both standardized mortality ratios ≈1.5) than the general population; however, after excluding those with noncardiac anomalies, >1-year mortality for those with nonsevere CHDs and >10-year and >20-year mortality for those with any CHD were similar to the general population. CONCLUSIONS Eight in 10 individuals with CHDs born between1980 and 1997 survived to 35 years of age, with disparities by CHD severity, noncardiac anomalies, birth weight, and maternal race and ethnicity. Among individuals without noncardiac anomalies, those with nonsevere CHDs experienced similar mortality between 1 and 35 years of age as in the general population, and those with any CHD experienced similar mortality between 10 and 35 years of age as in the general population.
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Affiliation(s)
- Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (K.F.D., C.E.R., M.E.O., S.L.F.)
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health and the Arkansas Center for Birth Defects Research and Prevention, University of Arkansas for Medical Sciences, Little Rock (W.N.N.)
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (K.F.D., C.E.R., M.E.O., S.L.F.)
| | - Jennifer G Andrews
- Department of Pediatrics, University of Arizona, Tucson (J.G.A., S.E.K.)
| | - Anthony Goudie
- Department of Pediatrics, Center for Applied Research and Evaluation, College of Medicine, Little Rock, AR (A.G.)
| | - Scott E Klewer
- Department of Pediatrics, University of Arizona, Tucson (J.G.A., S.E.K.)
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (K.F.D., C.E.R., M.E.O., S.L.F.)
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA (M.E.O.)
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (K.F.D., C.E.R., M.E.O., S.L.F.)
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Farr SL, Downing KF, Tepper NK, Oster ME, Glidewell MJ, Reefhuis J. Reproductive Health of Women with Congenital Heart Defects. J Womens Health (Larchmt) 2023; 32:132-137. [PMID: 36757282 PMCID: PMC10680443 DOI: 10.1089/jwh.2022.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
This report provides an overview of the unique reproductive health issues facing women with congenital heart defects (CHDs) and of the clinical care and professional guidelines on contraception, preconception care, and pregnancy for this population. It describes Centers for Disease Control and Prevention (CDC) activities related to surveillance of reproductive health issues among females with CHDs. It also describes CDC's work bringing awareness to physicians who provide care to adolescents and women with CHDs, including obstetrician/gynecologists, about the need for lifelong cardiology care for their patients with CHDs.
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Affiliation(s)
- Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naomi K Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew E Oster
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa J Glidewell
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Canfell OJ, Kodiyattu Z, Eakin E, Burton-Jones A, Wong I, Macaulay C, Sullivan C. Real-world data for precision public health of noncommunicable diseases: a scoping review. BMC Public Health 2022; 22:2166. [PMID: 36434553 PMCID: PMC9694563 DOI: 10.1186/s12889-022-14452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Global public health action to address noncommunicable diseases (NCDs) requires new approaches. NCDs are primarily prevented and managed in the community where there is little investment in digital health systems and analytics; this has created a data chasm and relatively silent burden of disease. The nascent but rapidly emerging area of precision public health offers exciting new opportunities to transform our approach to NCD prevention. Precision public health uses routinely collected real-world data on determinants of health (social, environmental, behavioural, biomedical and commercial) to inform precision decision-making, interventions and policy based on social position, equity and disease risk, and continuously monitors outcomes - the right intervention for the right population at the right time. This scoping review aims to identify global exemplars of precision public health and the data sources and methods of their aggregation/application to NCD prevention. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) was followed. Six databases were systematically searched for articles published until February 2021. Articles were included if they described digital aggregation of real-world data and 'traditional' data for applied community, population or public health management of NCDs. Real-world data was defined as routinely collected (1) Clinical, Medication and Family History (2) Claims/Billing (3) Mobile Health (4) Environmental (5) Social media (6) Molecular profiling (7) Patient-centred (e.g., personal health record). Results were analysed descriptively and mapped according to the three horizons framework for digital health transformation. RESULTS Six studies were included. Studies developed population health surveillance methods and tools using diverse real-world data (e.g., electronic health records and health insurance providers) and traditional data (e.g., Census and administrative databases) for precision surveillance of 28 NCDs. Population health analytics were applied consistently with descriptive, geospatial and temporal functions. Evidence of using surveillance tools to create precision public health models of care or improve policy and practice decisions was unclear. CONCLUSIONS Applications of real-world data and designed data to address NCDs are emerging with greater precision. Digital transformation of the public health sector must be accelerated to create an efficient and sustainable predict-prevent healthcare system.
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Affiliation(s)
- Oliver J. Canfell
- grid.1003.20000 0000 9320 7537Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD Australia ,grid.1003.20000 0000 9320 7537UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, QLD Australia ,grid.450426.10000 0001 0124 2253Digital Health Cooperative Research Centre, Australian Government, Sydney, NSW Australia ,grid.453171.50000 0004 0380 0628Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton, QLD Australia ,grid.1003.20000 0000 9320 7537Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, QLD Australia
| | - Zack Kodiyattu
- grid.1003.20000 0000 9320 7537School of Clinical Medicine, Faculty of Medicine, The University of Queensland, St Lucia, QLD Australia
| | - Elizabeth Eakin
- grid.1003.20000 0000 9320 7537School of Public Health, Faculty of Medicine, The University of Queensland, St Lucia, QLD Australia
| | - Andrew Burton-Jones
- grid.1003.20000 0000 9320 7537UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, QLD Australia
| | - Ides Wong
- grid.453171.50000 0004 0380 0628Department of Health, Office of the Chief Clinical Information Officer, Clinical Excellence Queensland, Queensland Government, Brisbane, QLD Australia
| | - Caroline Macaulay
- grid.453171.50000 0004 0380 0628Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton, QLD Australia
| | - Clair Sullivan
- grid.1003.20000 0000 9320 7537Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD Australia ,grid.453171.50000 0004 0380 0628Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton, QLD Australia ,grid.1003.20000 0000 9320 7537Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, QLD Australia ,grid.453171.50000 0004 0380 0628Department of Health, Metro North Hospital and Health Service, Queensland Government, Herston, QLD Australia
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Serfas J, Spates T, D’Ottavio A, Spears T, Ciociola E, Chiswell K, Davidson-Ray L, Ryan G, Forestieri N, Krasuski RA, Kemper AR, Hoffman TM, Walsh MJ, Sang CJ, Welke KF, Li JS. Disparities in Loss to Follow-Up Among Adults With Congenital Heart Disease in North Carolina. World J Pediatr Congenit Heart Surg 2022; 13:707-715. [DOI: 10.1177/21501351221111998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The AHA/ACC Adult Congenital Heart Disease guidelines recommend that most adults with congenital heart disease (CHD) follow-up with CHD cardiologists every 1 to 2 years because longer gaps in care are associated with adverse outcomes. This study aimed to determine the proportion of patients in North Carolina who did not have recommended follow-up and to explore predictors of loss to follow-up. Methods Patients ages ≥18 years with a healthcare encounter from 2008 to 2013 in a statewide North Carolina database with an ICD-9 code for CHD were assessed. The proportion with cardiology follow-up within 24 months following index encounter was assessed with Kaplan-Meier estimates. Cox regression was utilized to identify demographic factors associated with differences in follow-up. Results 2822 patients were identified. Median age was 35 years; 55% were female. 70% were white, 22% black, and 3% Hispanic; 36% had severe CHD. The proportion with 2-year cardiology follow-up was 61%. Those with severe CHD were more likely to have timely follow-up than those with less severe CHD (72% vs 55%, P < .01). Black patients had a lower likelihood of follow-up than white patients (56% vs 64%, P = .01). Multivariable Cox regression identified younger age, non-severe CHD, and non-white race as risk factors for a lower likelihood of follow-up by 2 years. Conclusion 39% of adults with CHD in North Carolina are not meeting AHA/ACC recommendations for follow-up. Younger and minority patients and those with non-severe CHD were particularly vulnerable to inadequate follow-up; targeted efforts to retain these patients in care may be helpful.
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Affiliation(s)
- J.D. Serfas
- Duke University Medical Center, Durham, NC, USA
| | - Toi Spates
- Duke University Medical Center, Durham, NC, USA
| | | | - Tracy Spears
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | - Grace Ryan
- Duke Clinical Research Institute, Durham, NC, USA
| | - Nina Forestieri
- State Center for Health Statistics, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | | | | | | | | | | | - Karl F. Welke
- Levine Children’s Hospital/Atrium Health, Charlotte, NC, USA
| | - Jennifer S. Li
- Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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Rodriguez FH, Raskind-Hood CL, Hoffman T, Farr SL, Glidewell J, Li JS, D'Ottavio A, Botto L, Reeder MR, Hsu D, Lui GK, Sullivan AM, Book WM. How Well Do ICD-9-CM Codes Predict True Congenital Heart Defects? A Centers for Disease Control and Prevention-Based Multisite Validation Project. J Am Heart Assoc 2022; 11:e024911. [PMID: 35862148 PMCID: PMC9375472 DOI: 10.1161/jaha.121.024911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The Centers for Disease Control and Prevention's Surveillance of Congenital Heart Defects Across the Lifespan project uses large clinical and administrative databases at sites throughout the United States to understand population-based congenital heart defect (CHD) epidemiology and outcomes. These individual databases are also relied upon for accurate coding of CHD to estimate population prevalence. Methods and Results This validation project assessed a sample of 774 cases from 4 surveillance sites to determine the positive predictive value (PPV) for identifying a true CHD case and classifying CHD anatomic group accurately based on 57 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Chi-square tests assessed differences in PPV by CHD severity and age. Overall, PPV was 76.36% (591/774 [95% CI, 73.20-79.31]) for all sites and all CHD-related ICD-9-CM codes. Of patients with a code for complex CHD, 89.85% (177/197 [95% CI, 84.76-93.69]) had CHD; corresponding PPV estimates were 86.73% (170/196 [95% CI, 81.17-91.15]) for shunt, 82.99% (161/194 [95% CI, 76.95-87.99]) for valve, and 44.39% (83/187 [95% CI, 84.76-93.69]) for "Other" CHD anatomic group (X2=142.16, P<0.0001). ICD-9-CM codes had higher PPVs for having CHD in the 3 younger age groups compared with those >64 years of age, (X2=4.23, P<0.0001). Conclusions While CHD ICD-9-CM codes had acceptable PPV (86.54%) (508/587 [95% CI, 83.51-89.20]) for identifying whether a patient has CHD when excluding patients with ICD-9-CM codes for "Other" CHD and code 745.5, further evaluation and algorithm development may help inform and improve accurate identification of CHD in data sets across the CHD ICD-9-CM code groups.
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Affiliation(s)
- Fred H Rodriguez
- Division of Cardiology Emory University School of Medicine and Emory University Rollins School of Public Health Atlanta GA.,Sibley Heart Center Cardiology Atlanta GA
| | - Cheryl L Raskind-Hood
- Division of Cardiology Emory University School of Medicine and Emory University Rollins School of Public Health Atlanta GA
| | - Trenton Hoffman
- Division of Cardiology Emory University School of Medicine and Emory University Rollins School of Public Health Atlanta GA
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention Atlanta GA
| | - Jill Glidewell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention Atlanta GA
| | | | | | - Lorenzo Botto
- Division of Medical Genetics, Department of Pediatrics University of Utah Salt Lake City UT
| | - Matthew R Reeder
- Division of Medical Genetics, Department of Pediatrics University of Utah Salt Lake City UT
| | - Daphne Hsu
- Albert Einstein College of Medicine and The Children"s Hospital at Montefiore Bronx NY
| | - George K Lui
- Divisions of Cardiovascular Medicine and Pediatric Cardiology Stanford University School of Medicine Palo Alto CA
| | - Anaclare M Sullivan
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology Albany NY
| | - Wendy M Book
- Division of Cardiology Emory University School of Medicine and Emory University Rollins School of Public Health Atlanta GA
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Early-onset dementia among privately-insured adults with and without congenital heart defects in the United States, 2015–2017. Int J Cardiol 2022; 358:34-38. [DOI: 10.1016/j.ijcard.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/16/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022]
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9
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Downing KF, Simeone RM, Oster ME, Farr SL. Critical Illness Among Patients Hospitalized With Acute COVID-19 With and Without Congenital Heart Defects. Circulation 2022; 145:1182-1184. [PMID: 35249378 PMCID: PMC8989604 DOI: 10.1161/circulationaha.121.057833] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Karrie F Downing
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Regina M Simeone
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Simeone RM, Downing KF, Bobo WV, Grosse SD, Khanna AD, Farr SL. Post-traumatic stress disorder, anxiety, and depression among adults with congenital heart defects. Birth Defects Res 2022; 114:124-135. [PMID: 34935303 PMCID: PMC8828688 DOI: 10.1002/bdr2.1971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Due to invasive treatments and stressors related to heart health, adults with congenital heart defects (CHDs) may have an increased risk of post-traumatic stress disorder (PTSD), anxiety, and/or depressive disorders. Our objectives were to estimate the prevalence of these disorders among individuals with CHDs. METHODS Using IBM® MarketScan® Databases, we identified adults age 18-49 years with ≥2 outpatient anxiety/depressive disorder claims on separate dates or ≥1 inpatient anxiety/depressive disorder claim in 2017. CHDs were defined as ≥2 outpatient CHD claims ≥30 days apart or ≥1 inpatient CHD claim documented in 2007-2017. We used log-binomial regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between CHDs and anxiety/depressive disorders. RESULTS Of 13,807 adults with CHDs, 12.4% were diagnosed with an anxiety or depressive disorder. Adults with CHDs, compared to the 5,408,094 without CHDs, had higher prevalence of PTSD (0.8% vs. 0.5%; aPR: 1.5 [CI: 1.2-1.8]), anxiety disorders (9.9% vs. 7.5%; aPR: 1.3 [CI: 1.3-1.4]), and depressive disorders (6.3% vs. 4.9%; aPR: 1.3 [CI: 1.2-1.4]). Among individuals with CHDs, female sex (aPR range: 1.6-3.3) and inpatient admission (aPR range 1.1-1.9) were associated with anxiety/depressive disorders. CONCLUSION Over 1 in 8 adults with CHDs had diagnosed PTSD and/or other anxiety/depressive disorders, 30-50% higher than adults without CHDs. PTSD was rare, but three times more common in women with CHDs than men. Screening and referral for services for these conditions in people with CHDs may be beneficial.
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Affiliation(s)
- Regina M. Simeone
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amber D. Khanna
- Department of Internal Medicine, Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,Department of Pediatrics, Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Farr SL, Riley C, Van Zutphen AR, Brei TJ, Leedom VO, Kirby RS, Pabst LJ. Prevention and awareness of birth defects across the lifespan using examples from congenital heart defects and spina bifida. Birth Defects Res 2021; 114:35-44. [PMID: 34921598 DOI: 10.1002/bdr2.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Sherry L Farr
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
| | - Catharine Riley
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
| | - Alissa R Van Zutphen
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Timothy J Brei
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA.,Spina Bifida Association of America, Arlington, Virginia, USA
| | - Vinita Oberoi Leedom
- Division of Population Health Surveillance, South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | | | - Laura J Pabst
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
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Farr SL, Downing KF, Goudie A, Klewer SE, Andrews JG, Oster ME. Advance Care Directives Among a Population-Based Sample of Young Adults with Congenital Heart Defects, CH STRONG, 2016-2019. Pediatr Cardiol 2021; 42:1775-1784. [PMID: 34164699 PMCID: PMC9808577 DOI: 10.1007/s00246-021-02663-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/14/2021] [Indexed: 01/05/2023]
Abstract
Little is known about advance care planning among young adults with congenital heart defects (CHD). Congenital Heart Survey to Recognize Outcomes, Needs, and well-beinG (CH STRONG) participants were born with CHD between 1980 and 1997, identified using active, population-based birth defects surveillance systems in Arkansas, Arizona and Atlanta, and Georgia, and surveyed during 2016-2019. We estimated the percent having an advance care directive standardized to the site, year of birth, sex, maternal race, and CHD severity of the 9312 CH STRONG-eligible individuals. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for characteristics associated with having advance care directives. Of 1541 respondents, 34.1% had severe CHD, 54.1% were female, and 69.6% were non-Hispanic white. After standardization, 7.3% had an advance care directive (range: 2.5% among non-Hispanic blacks to 17.4% among individuals with "poor" perceived health). Individuals with severe CHD (10.5%, aOR = 1.6, 95% CI: 1.1-2.3), with public insurance (13.1%, aOR = 1.7, 95% CI: 1.1-2.7), with non-cardiac congenital anomalies (11.1%, aOR = 1.9, 95% CI: 1.3-2.7), and who were hospitalized in the past year (13.3%, aOR = 1.8, 95% CI: 1.1-2.8) were more likely than their counterparts to have advance care directives. Individuals aged 19-24 years (6.6%, aOR = 0.4, 95% CI: 0.3-0.7) and 25-30 years (7.6%, aOR = 0.5, 95% CI: 0.3-0.8), compared to 31-38 years (14.3%), and non-Hispanic blacks (2.5%), compared to non-Hispanic whites (9.5%, aOR = 0.2, 95% CI: 0.1-0.6), were less likely to have advance care directives. Few young adults with CHD had advance care directives. Disparities in advance care planning may exist.
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Affiliation(s)
- Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS 106-3, Atlanta, GA, 30341, USA.
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS 106-3, Atlanta, GA, 30341, USA
| | - Anthony Goudie
- Department of Pediatrics, Center for Applied Research and Evaluation, College of Medicine, Little Rock, AR, USA
| | - Scott E Klewer
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | | | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS 106-3, Atlanta, GA, 30341, USA
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
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13
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Downing KF, Oster ME, Klewer SE, Rose CE, Nembhard WN, Andrews JG, Farr SL. Disability Among Young Adults With Congenital Heart Defects: Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being 2016-2019. J Am Heart Assoc 2021; 10:e022440. [PMID: 34666499 PMCID: PMC8751822 DOI: 10.1161/jaha.121.022440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Disabilities have implications for health, well‐being, and health care, yet limited information is available on the percentage of adults with congenital heart defects (CHD) living with disabilities. We evaluated the prevalence of disability and associated characteristics among the 2016–2019 CH STRONG (Congenital Heart Survey to Recognize Outcomes, Needs, and Well‐Being) population‐based sample of 19‐ to 38‐year‐olds with CHD from 3 US locations. Methods and Results Prevalence of disability types (hearing, vision, cognition, mobility, self‐care, living independently) were compared with similarly aged adults from the general population as estimated by the American Community Survey and standardized to the CH STRONG eligible population to reduce nonresponse bias and confounding. Health‐related quality of life (HRQOL) was measured via Patient‐Reported Outcomes Measurement Information System Global Health Scale T‐scores standardized to US 18‐ to 34‐year‐olds. Separate multivariable regression models assessed associations between disability and HRQOL. Of 1478 participants, 40% reported disabilities, with cognition most prevalent (29%). Of those reporting disability, 45% ever received disability benefits and 46% were unemployed. Prevalence of disability types were 5 to 8 times higher in adults with CHD than the general population. Those with ≥1 disability had greater odds of being female, and of having non‐Hispanic Black maternal race and ethnicity, severe CHD, recent cardiac care, and noncardiac congenital anomalies. On average, adults with CHD and cognition, mobility, and self‐care disabilities had impaired mental HRQOL and those with any disability type had impaired physical HRQOL. Conclusions Two of 5 adults with CHD may have disabilities, which are associated with impaired HRQOL. These results may inform healthcare needs and services for this growing population.
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Affiliation(s)
- Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA.,Children's Healthcare of Atlanta and Emory University School of Medicine Atlanta GA
| | - Scott E Klewer
- Department of Pediatrics University of Arizona Tucson AZ
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Wendy N Nembhard
- Department of Epidemiology Fay W Boozman College of Public Health and the Arkansas Center for Birth Defects Research and Prevention University of Arkansas for Medical Sciences Little Rock AR
| | | | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
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14
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Anderson BR, Dragan K, Crook S, Woo JL, Cook S, Hannan EL, Newburger JW, Jacobs M, Bacha EA, Vincent R, Nguyen K, Walsh-Spoonhower K, Mosca R, Devejian N, Kamenir SA, Alfieris GM, Swartz MF, Meyer D, Paul EA, Billings J. Improving Longitudinal Outcomes, Efficiency, and Equity in the Care of Patients With Congenital Heart Disease. J Am Coll Cardiol 2021; 78:1703-1713. [PMID: 34674815 DOI: 10.1016/j.jacc.2021.08.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Longitudinal follow-up, resource utilization, and health disparities are top congenital heart research and care priorities. Medicaid claims include longitudinal data on inpatient, outpatient, emergency, pharmacy, rehabilitation, home health utilization, and social determinants of health-including mother-infant pairs. OBJECTIVES The New York Congenital Heart Surgeons Collaborative for Longitudinal Outcomes and Utilization of Resources linked robust clinical details from locally held state and national registries from 10 of 11 New York congenital heart centers to Medicaid claims, building a novel, statewide mechanism for longitudinal assessment of outcomes, expenditures, and health inequities. METHODS The authors included all children <18 years of age undergoing cardiac surgery in The Society of Thoracic Surgeons Congenital Heart Surgery Database or the New York State Pediatric Congenital Cardiac Surgery Registry from 10 of 11 New York centers, 2006 to 2019. Data were linked via iterative, ranked deterministic matching on direct identifiers. Match rates were calculated and compared. Proportions of the linked cohort trackable over 3, 5, and 10 years were described. RESULTS Of 14,097 registry cases, 59% (n = 8,322) reported Medicaid use. Of these, 7,414 were linked to New York claims, at an 89% match rate. Of matched cases, the authors tracked 79%, 74%, and 65% of children over 3, 5, and 10 years when requiring near-continuous Medicaid enrollment. Allowing more lenient enrollment criteria, the authors tracked 86%, 82%, and 76%, respectively. Mortality over this time was 7.7%, 8.4%, and 10.0%, respectively. Manual validation revealed ∼100% true matches. CONCLUSIONS This establishes a novel statewide data resource for assessment of longitudinal outcome, health expenditure, and disparities for children with congenital heart disease.
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Affiliation(s)
- Brett R Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
| | - Kacie Dragan
- Wagner Graduate School of Public Service, New York University, New York, New York, USA
| | - Sarah Crook
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Joyce L Woo
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Stephen Cook
- Offices of Health Insurance Programs, New York State Department of Health, Albany, New York, USA
| | - Edward L Hannan
- School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Jane W Newburger
- Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Marshall Jacobs
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emile A Bacha
- Department of Cardiothoracic Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Weill Cornell Medical Center, New York, New York, USA
| | - Robert Vincent
- Division of Pediatric Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Khanh Nguyen
- Department of Cardiac Surgery, Westchester Medical Center, Valhalla, New York, USA
| | | | - Ralph Mosca
- Department of Cardiothoracic Surgery, New York University, New York, New York, USA
| | - Neil Devejian
- Division of Pediatric Cardiothoracic Surgery, Albany Medical College, Albany, New York, USA
| | - Steven A Kamenir
- Division of Pediatric Cardiology, Albany Medical College, Albany, New York, USA
| | - George M Alfieris
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Surgery, State University of New York Upstate Medical Center, Syracuse, New York, USA
| | - Michael F Swartz
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - David Meyer
- Department of Cardiothoracic Surgery, Hofstra-Northwell School of Medicine, Uniondale, New York, USA; Department of Pediatrics, Hofstra-Northwell School of Medicine, Uniondale, New York, USA
| | - Erin A Paul
- Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Billings
- Wagner Graduate School of Public Service, New York University, New York, New York, USA
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Abstract
OBJECTIVE To evaluate outcomes in patients with Turner Syndrome, especially those with cardiac conditions, compared to those without Turner syndrome. DESIGN Retrospective cohort study utilising hospitalisation data from 2006 to 2012. Conditional logistic regression models are used to analyse outcomes of interest: all-cause mortality, increased length of stay, and discharge to home. PARTICIPANTS We identified 2978 women with Turner syndrome, matched to 11,912 controls by primary diagnosis. RESULTS Patients with Turner syndrome were more likely to experience inpatient mortality (odds ratio 1.44, 95% confidence interval 1.02-2.02, p = 0.04) and increased length of stay (OR 1.31, CI 1.18-1.46, p = 0.03) than primary diagnosis matched controls, after adjusting for age, race, insurance status, and Charlson comorbidity index. Patients with Turner syndrome were 32% less likely to be discharged to home (OR 0.68, CI 0.60-0.78, p < 0.001). When restricting the sample of patients to those admitted with a cardiac diagnosis, the likelihood of mortality (OR 3.10, CI 1.27-7.57, p = 0.01) and prolonged length of stay (OR 1.42, CI 1.03-1.95, p = 0.03) further increased, while the likelihood of discharge to home further decreased (OR 0.55, CI 0.38-0.80, p = 0.001) in Turner syndrome compared to primary diagnosis matched controls. Specifically, patients with congenital heart disease were more likely to have prolonged length of stay (OR: 1.53, CI 1.18-2.00, p = 0.002), but not increased mortality or decreased discharge to home. CONCLUSIONS Hospitalised women with Turner syndrome carry a higher risk of adverse outcomes even when presenting otherwise similarly as controls, an important consideration for those treating them in these settings.
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Individuals aged 1-64 years with documented congenital heart defects at healthcare encounters, five U.S. surveillance sites, 2011-2013. Am Heart J 2021; 238:100-108. [PMID: 33951414 DOI: 10.1016/j.ahj.2021.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many individuals born with congenital heart defects (CHD) survive to adulthood. However, population estimates of CHD beyond early childhood are limited in the U.S. OBJECTIVES To estimate the percentage of individuals aged 1-to-64 years at five U.S. sites with CHD documented at a healthcare encounter during a three-year period and describe their characteristics. METHODS Sites conducted population-based surveillance of CHD among 1 to 10-year-olds (three sites) and 11 to 64-year-olds (all five sites) by linking healthcare data. Eligible cases resided in the population catchment areas and had one or more healthcare encounters during the surveillance period (January 1, 2011-December 31, 2013) with a CHD-related ICD-9-CM code. Site-specific population census estimates from the same age groups and time period were used to assess percentage of individuals in the catchment area with a CHD-related ICD-9-CM code documented at a healthcare encounter (hereafter referred to as CHD cases). Severe and non-severe CHD were based on an established mutually exclusive anatomic hierarchy. RESULTS Among 42,646 CHD cases, 23.7% had severe CHD and 51.5% were male. Percentage of CHD cases among 1 to 10-year-olds, was 6.36/1,000 (range: 4.33-9.96/1,000) but varied by CHD severity [severe: 1.56/1,000 (range: 1.04-2.64/1,000); non-severe: 4.80/1,000 (range: 3.28-7.32/1,000)]. Percentage of cases across all sites in 11 to 64-year-olds was 1.47/1,000 (range: 1.02-2.18/1,000) and varied by CHD severity [severe: 0.34/1,000 (range: 0.26-0.49/1,000); non-severe: 1.13/1,000 (range: 0.76-1.69/1,000)]. Percentage of CHD cases decreased with age until 20 to 44 years and, for non-severe CHD only, increased slightly for ages 45 to 64 years. CONCLUSION CHD cases varied by site, CHD severity, and age. These findings will inform planning for the needs of this growing population.
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17
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Williams JL, Torok RD, D'Ottavio A, Spears T, Chiswell K, Forestieri NE, Sang CJ, Paolillo JA, Walsh MJ, Hoffman TM, Kemper AR, Li JS. Causes of Death in Infants and Children with Congenital Heart Disease. Pediatr Cardiol 2021; 42:1308-1315. [PMID: 33890132 DOI: 10.1007/s00246-021-02612-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 01/22/2023]
Abstract
With improved surgical outcomes, infants and children with congenital heart disease (CHD) may die from other causes of death (COD) other than CHD. We sought to describe the COD in youth with CHD in North Carolina (NC). Patients from birth to 20 years of age with a healthcare encounter between 2008 and 2013 in NC were identified by ICD-9 code. Patients who could be linked to a NC death certificate between 2008 and 2016 were included. Patients were divided by CHD subtypes (severe, shunt, valve, other). COD was compared between groups. Records of 35,542 patients < 20 years old were evaluated. There were 15,277 infants with an annual mortality rate of 3.5 deaths per 100 live births. The most frequent COD in infants (age < 1 year) were CHD (31.7%), lung disease (16.1%), and infection (11.4%). In 20,265 children (age 1 to < 20 years), there was annual mortality rate of 9.7 deaths per 1000 at risk. The most frequent COD in children were CHD (34.2%), neurologic disease (10.2%), and infection (9.5%). In the severe subtype, CHD was the most common COD. In infants with shunt-type CHD disease, lung disease (19.5%) was the most common COD. The mortality rate in infants was three times higher when compared to children. CHD is the most common underlying COD, but in those with shunt-type lesions, extra-cardiac COD is more common. A multidisciplinary approach in CHD patients, where development of best practice models regarding comorbid conditions such as lung disease and neurologic disease could improve outcomes in this patient population.
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Affiliation(s)
- Jason L Williams
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Box 3090, Durham, NC, 27710, USA
| | - Rachel D Torok
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Box 3090, Durham, NC, 27710, USA
| | - Alfred D'Ottavio
- Duke Clinical Research Institute, Duke University Medical Center, Box 3090, Durham, NC, 27710, USA
| | - Tracy Spears
- Duke Clinical Research Institute, Duke University Medical Center, Box 3090, Durham, NC, 27710, USA
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University Medical Center, Box 3090, Durham, NC, 27710, USA
| | - Nina E Forestieri
- North Carolina Division of Public Health, Birth Defects Monitoring Program, State Center for Health Statistics, Raleigh, NC, USA
| | - Charlie J Sang
- Department of Pediatrics, Division of Pediatric Cardiology, Vidant Medical Center, Greenville, NC, USA
| | - Joseph A Paolillo
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC, USA
| | - Michael J Walsh
- Department of Pediatrics, Division of Pediatric Cardiology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Timothy M Hoffman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Alex R Kemper
- Department of Pediatrics, Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer S Li
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Box 3090, Durham, NC, 27710, USA. .,Duke Clinical Research Institute, Duke University Medical Center, Box 3090, Durham, NC, 27710, USA.
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Insaf TZ, Sommerhalter KM, Jaff TA, Farr SL, Downing KF, Zaidi AN, Lui GK, Van Zutphen AR. Access to cardiac surgery centers for cardiac and non-cardiac hospitalizations in adolescents and adults with congenital heart defects- a descriptive case series study. Am Heart J 2021; 236:22-36. [PMID: 33636136 PMCID: PMC8097661 DOI: 10.1016/j.ahj.2021.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/19/2021] [Indexed: 01/14/2023]
Abstract
Background Individuals with congenital heart defects (CHDs) are recommended to receive all inpatient cardiac and noncardiac care at facilities that can offer specialized care. We describe geographic accessibility to such centers in New York State and determine several factors associated with receiving care there. Methods We used inpatient hospitalization data from the Statewide Planning and Research Cooperative System (SPARCS) in New York State 2008–2013. In the absence of specific adult CHD care center designations during our study period, we identified pediatric/adult and adult-only cardiac surgery centers through the Cardiac Surgery Reporting System to estimate age-based specialized care. We calculated one-way drive and public transit time (in minutes) from residential address to centers using R gmapsdistance package and the Google Maps Distance Application Programming Interface (API). We calculated prevalence ratios using modified Poisson regression with model-based standard errors, fit with generalized estimating equations clustered at the hospital level and subclustered at the individual level. Results Individuals with CHDs were more likely to seek care at pediatric/adult or adult-only cardiac surgery centers if they had severe CHDs, private health insurance, higher severity of illness at encounter, a surgical procedure, cardiac encounter, and shorter drive time. These findings can be used to increase care receipt (especially for noncardiac care) at pediatric/adult or adult-only cardiac surgery centers, identify areas with limited access, and reduce disparities in access to specialized care among this high-risk population.
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Affiliation(s)
- Tabassum Z Insaf
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
| | | | - Treeva A Jaff
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
| | - Sherry L Farr
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Ali N Zaidi
- Adult Congenital Heart Disease Center, Mount Sinai Heart/Icahn School of Medicine at Mount Sinai, New York, NY
| | - George K Lui
- Stanford University School of Medicine, Stanford, CA
| | - Alissa R Van Zutphen
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
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Hsu WH, Sommerhalter KM, McGarry CE, Farr SL, Downing KF, Lui GK, Zaidi AN, Hsu DT, Van Zutphen AR. Inpatient admissions and costs for adolescents and young adults with congenital heart defects in New York, 2009-2013. Birth Defects Res 2020; 113:173-188. [PMID: 32990389 DOI: 10.1002/bdr2.1809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Most individuals born with congenital heart defects (CHDs) survive to adulthood, but healthcare utilization patterns for adolescents and adults with CHDs have not been well described. We sought to characterize the healthcare utilization patterns and associated costs for adolescents and young adults with CHDs. METHODS We examined 2009-2013 New York State inpatient admissions of individuals ages 11-30 years with ≥1 CHD diagnosis codes recorded during any admission. We conducted multivariate linear regression using generalized estimating equations to examine associations between inpatient costs and sociodemographic and clinical variables. RESULTS We identified 5,100 unique individuals with 9,593 corresponding hospitalizations over the study period. Median inpatient cost and length of stay (LOS) were $10,720 and 3.0 days per admission, respectively; 55.1% were emergency admissions. Admission volume increased 48.7% from 2009 (1,538 admissions) to 2013 (2,287 admissions), while total inpatient costs increased 91.8% from 2009 ($27.2 million) to 2013 ($52.2 million). Inpatient admissions and costs rose more sharply over the study period for those with nonsevere CHDs compared to severe CHDs. Characteristics associated with higher costs were longer LOS, severe CHD, cardiac/vascular hospitalization classification, surgical procedures, greater severity of illness, and admission in New York City. CONCLUSION This study provides an informative baseline of health care utilization patterns and associated costs among adolescents and young adults with CHDs in New York State. Structured transition programs may aid in keeping this population in appropriate cardiac care as they move to adulthood.
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Affiliation(s)
- Wan-Hsiang Hsu
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA
| | - Kristin M Sommerhalter
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA
| | - Claire E McGarry
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - George K Lui
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Stanford School of Medicine, Stanford, California, USA
| | - Ali N Zaidi
- Sinai Adult Congenital Heart Disease Program, Mount Sinai Cardiovascular Institute & The Pediatric Heart Center, New York, New York, USA
| | - Daphne T Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alissa R Van Zutphen
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA.,University at Albany School of Public Health, Rensselaer, New York, USA
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20
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Predicting 30-day readmission after congenital heart surgery across the lifespan. Cardiol Young 2020; 30:1297-1304. [PMID: 32753074 DOI: 10.1017/s1047951120002012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hospital readmission is an important driver of costs among patients with CHD. We assessed predictors of 30-day rehospitalisation following cardiac surgery in CHD patients across the lifespan. METHODS This was a retrospective analysis of 981 patients with CHD who had cardiac surgery between January 2011 and December 2012. A multivariate logistic regression model was used to identify demographic, clinical, and surgical predictors of 30-day readmission. Receiver operating curves derived from multivariate logistic modelling were utilised to discriminate between patients who were readmitted and not-readmitted at 30 days. Model goodness of fit was assessed using the Hosmer-Lemeshow test statistic. RESULTS Readmission in the 30 days following congenital heart surgery is common (14.0%). Among 981 patients risk factors associated with increased odds of 30-day readmission after congenital heart surgery through multivariate analysis included a history of previous cardiac surgery (p < 0.001), longer post-operative length of stay (p < 0.001), as well as nutritional (p < 0.001), haematologic (p < 0.02), and endocrine (p = 0.04) co-morbidities. Patients who underwent septal defect repair had reduced odds of readmission (p < 0.001), as did children (p = 0.04) and adult (p = 0.005) patients relative to neonates. CONCLUSION Risk factors for readmission include a history of cardiac surgery, longer length of stay, and co-morbid conditions. This information may serve to guide efforts to prevent readmission and inform resource allocation in the transition of care to the outpatient setting. This study also demonstrated the feasibility of linking a national subspecialty registry to a clinical and administrative data repository to follow longitudinal outcomes of interest.
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21
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Population-level surveillance of congenital heart defects among adolescents and adults in Colorado: Implications of record linkage. Am Heart J 2020; 226:75-84. [PMID: 32526532 DOI: 10.1016/j.ahj.2020.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/14/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The objective was to describe the design of a population-level electronic health record (EHR) and insurance claims-based surveillance system of adolescents and adults with congenital heart defects (CHDs) in Colorado and to evaluate the bias introduced by duplicate cases across data sources. METHODS The Colorado CHD Surveillance System ascertained individuals aged 11-64 years with a CHD based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic coding between 2011 and 2013 from a diverse network of health care systems and an All Payer Claims Database (APCD). A probability-based identity reconciliation algorithm identified duplicate cases. Logistic regression was conducted to investigate bias introduced by duplicate cases on the relationship between CHD severity (severe compared to moderate/mild) and adverse outcomes including all-cause mortality, inpatient hospitalization, and major adverse cardiac events (myocardial infarction, congestive heart failure, or cerebrovascular event). Sensitivity analyses were conducted to investigate bias introduced by the sole use or exclusion of APCD data. RESULTS A total of 12,293 unique cases were identified, of which 3,476 had a within or between data source duplicate. Duplicate cases were more likely to be in the youngest age group and have private health insurance, a severe heart defect, a CHD comorbidity, and higher health care utilization. We found that failure to resolve duplicate cases between data sources would inflate the relationship between CHD severity and both morbidity and mortality outcomes by ~15%. Sensitivity analyses indicate that scenarios in which APCD was excluded from case finding or relied upon as the sole source of case finding would also result in an overestimation of the relationship between a CHD severity and major adverse outcomes. DISCUSSION Aggregated EHR- and claims-based surveillance systems of adolescents and adults with CHD that fail to account for duplicate records will introduce considerable bias into research findings. CONCLUSION Population-level surveillance systems for rare chronic conditions, such as congenital heart disease, based on aggregation of EHR and claims data require sophisticated identity reconciliation methods to prevent bias introduced by duplicate cases.
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Gaydos LM, Sommerhalter K, Raskind-Hood C, Fapo O, Lui G, Hsu D, Van Zutphen A, Glidewell J, Farr S, Rodriguez FH, Hoffman T, Book W. Health Care Transition Perceptions Among Parents of Adolescents with Congenital Heart Defects in Georgia and New York. Pediatr Cardiol 2020; 41:1220-1230. [PMID: 32500288 PMCID: PMC9109153 DOI: 10.1007/s00246-020-02378-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Abstract
With increasing survival trends for children and adolescents with congenital heart defects (CHD), there is a growing need to focus on transition from pediatric to adult specialty cardiac care. To better understand parental perspectives on the transition process, a survey was distributed to 451 parents of adolescents with CHD who had recent contact with the healthcare system in Georgia (GA) and New York (NY). Among respondents, 90.7% reported excellent, very good or good health-related quality of life (HRQoL) for their adolescent. While the majority of parents (77.8%) had been told by a provider about their adolescent's need to transition to adult specialty cardiac care, most reported concerns about transitioning to adult care. Parents were most commonly concerned with replacing the strong relationship with pediatric providers (60.7%), locating an appropriate adult provider (48.7%), and accessing adult health insurance coverage (43.6%). These findings may offer insights into transition planning for adolescents with CHD.
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Affiliation(s)
- Laura M Gaydos
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | | | - Olushola Fapo
- New York State Department of Health, Albany, NY, USA
| | - George Lui
- Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford School of Medicine, Stanford, CA, USA
| | - Daphne Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Alissa Van Zutphen
- New York State Department of Health, Albany, NY, USA
- University at Albany School of Public Health, Rensselaer, NY, USA
| | - Jill Glidewell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sherry Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Trenton Hoffman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Wendy Book
- Emory University School of Medicine, Atlanta, GA, USA
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23
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Goldstein SA, D'Ottavio A, Spears T, Chiswell K, Hartman RJ, Krasuski RA, Kemper AR, Meyer RE, Hoffman TM, Walsh MJ, Sang CJ, Paolillo J, Li JS. Causes of Death and Cardiovascular Comorbidities in Adults With Congenital Heart Disease. J Am Heart Assoc 2020; 9:e016400. [PMID: 32654582 PMCID: PMC7660712 DOI: 10.1161/jaha.119.016400] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Little is known about the contemporary mortality experience among adults with congenital heart disease (CHD). The objectives of this study were to assess the age at death, presence of cardiovascular comorbidities, and most common causes of death among adults with CHD in a contemporary cohort within the United States. Methods and Results Patients with CHD who had a healthcare encounter between 2008 and 2013 at 1 of 5 comprehensive CHD centers in North Carolina were identified by International Classification of Diseases, Ninth Revision (ICD-9), code. Only patients who could be linked to a North Carolina death certificate between 2008 and 2016 and with age at death ≥20 years were included. Median age at death and underlying cause of death based on death certificate data were analyzed. The prevalence of acquired cardiovascular risk factors was determined from electronic medical record data. Among the 629 included patients, the median age at death was 64.2 years. Those with severe CHD (n=157, 25%), shunts (n=202, 32%), and valvular lesions (n=174, 28%) had a median age at death of 46.0, 65.0, and 73.3 years, respectively. Cardiovascular death was most common in adults with severe CHD (60%), with 40% of those deaths caused by CHD. Malignancy and ischemic heart disease were the most common causes of death in adults with nonsevere CHD. Hypertension and hyperlipidemia were common comorbidities among all CHD severity groups. Conclusions The most common underlying causes of death differed by lesion severity. Those with severe lesions most commonly died from underlying CHD, whereas those with nonsevere disease more commonly died from non-CHD causes.
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Affiliation(s)
- Sarah A Goldstein
- Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
| | | | | | | | | | | | | | | | | | | | | | | | - Jennifer S Li
- Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
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24
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Tompkins R, Khan A. ACHD Care in the United States. J Am Coll Cardiol 2020; 76:183-185. [DOI: 10.1016/j.jacc.2020.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/29/2022]
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25
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Gurvitz M, Dunn JE, Bhatt A, Book WM, Glidewell J, Hogue C, Lin AE, Lui G, McGarry C, Raskind-Hood C, Van Zutphen A, Zaidi A, Jenkins K, Riehle-Colarusso T. Characteristics of Adults With Congenital Heart Defects in the United States. J Am Coll Cardiol 2020; 76:175-182. [DOI: 10.1016/j.jacc.2020.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
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26
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Downing KF, Tepper NK, Simeone RM, Ailes EC, Gurvitz M, Boulet SL, Honein MA, Howards PP, Valente AM, Farr SL. Adverse Pregnancy Conditions Among Privately Insured Women With and Without Congenital Heart Defects. Circ Cardiovasc Qual Outcomes 2020; 13:e006311. [PMID: 32506927 DOI: 10.1161/circoutcomes.119.006311] [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] [Indexed: 11/16/2022]
Abstract
Background In women with congenital heart defects (CHD), changes in blood volume, heart rate, respiration, and edema during pregnancy may lead to increased risk of adverse outcomes and conditions. The American Heart Association recommends providers of pregnant women with CHD assess cardiac health and discuss risks and benefits of cardiac-related medications. We described receipt of American Heart Association-recommended cardiac evaluations, filled potentially teratogenic or fetotoxic (Food and Drug Administration pregnancy category D/X) cardiac-related prescriptions, and adverse conditions among pregnant women with CHD compared with those without CHD. Methods and Results Using 2007 to 2014 US healthcare claims data, we ascertained a retrospective cohort of women with and without CHD aged 15 to 44 years with private insurance covering prescriptions during pregnancy. CHD was defined as ≥1 inpatient code or ≥2 outpatient CHD diagnosis codes >30 days apart documented outside of pregnancy and categorized as severe or nonsevere. Log-linear regression, accounting for multiple pregnancies per woman, generated adjusted prevalence ratios (aPRs) for associations between the presence/severity of CHD and stillbirth, preterm birth, and adverse conditions from the last menstrual period to 90 days postpartum. We identified 2056 women with CHD (2334 pregnancies) and 1 374 982 women without (1 524 077 pregnancies). During the last menstrual period to 90 days postpartum, 56% of women with CHD had comprehensive echocardiograms and, during pregnancy, 4% filled potentially teratogenic or fetotoxic cardiac-related prescriptions. Women with CHD, compared with those without, experienced more adverse conditions overall (aPR, 1.9 [95% CI, 1.7-2.1]) and, specifically, obstetric (aPR, 1.3 [95% CI, 1.2-1.4]) and cardiac conditions (aPR, 10.2 [95% CI, 9.1-11.4]), stillbirth (aPR, 1.6 [95% CI, 1.1-2.4]), and preterm delivery (aPR, 1.6 [95% CI, 1.4-1.8]). More women with severe CHD, compared with nonsevere, experienced adverse conditions overall (aPR, 1.5 [95% CI, 1.2-1.9]). Conclusions Women with CHD have elevated prevalence of adverse cardiac and obstetric conditions during pregnancy; 4 in 100 used potentially teratogenic or fetotoxic medications, and only half received an American Heart Association-recommended comprehensive echocardiogram.
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Affiliation(s)
- Karrie F Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (N.K.T.), Centers for Disease Control and Prevention, Atlanta, GA
| | - Regina M Simeone
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth C Ailes
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (M.G., A.M.V.).,Department of Medicine, Division of Cardiovascular Disease, Brigham and Women's Hospital, Boston, MA (M.G., A.M.V.)
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA (S.L.B.)
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Anne M Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (M.G., A.M.V.).,Department of Medicine, Division of Cardiovascular Disease, Brigham and Women's Hospital, Boston, MA (M.G., A.M.V.)
| | - Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
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Schlichting LE, Insaf T, Lui G, Zaidi A, Van Zutphen A. Proximity to risk-appropriate perinatal hospitals for pregnant women with congenital heart defects in New York state. BMC Pregnancy Childbirth 2020; 20:338. [PMID: 32487099 PMCID: PMC7268637 DOI: 10.1186/s12884-020-03025-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background Women with congenital heart defects (CHDs) experiencing pregnancies require specialized delivery care and extensive monitoring that may not be available at all birthing hospitals. In this study, we examined proximity to, and delivery at, a hospital with an appropriate level of perinatal care for pregnant women with CHDs and evaluated predictors of high travel distance to appropriate care. Appropriate care was defined as Level 3 perinatal hospitals and Regional Perinatal Centers (RPCs). Methods Inpatient delivery records for women with CHD in New York State (NYS) between 2008 and 2013 were obtained. Driving time and transit time were calculated between the pregnant woman’s residence and the actual delivery hospital as well as the closest Level 3 or RPC hospital using Geographic Information Systems (GIS). Linear and logistic regression models evaluated predictors of high distance to, and utilization of, appropriate delivery care respectively. Results From 2008 to 2013, there were 909 deliveries in a NYS hospital by women with CHDs. Approximately 75% of women delivered at a Level 3 or RPC hospital. Younger women, those who reside in rural and smaller urban areas, and those who are non-Hispanic White had a greater drive time to an appropriate care facility. After adjustment for geographic differences, racial/ethnic minorities and poor women were less likely to deliver at an appropriate delivery care center. Conclusions Although most women with CHDs in NYS receive appropriate delivery care, there are some geographic and socio-demographic differences that require attention to ensure equitable access.
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Affiliation(s)
- Lauren E Schlichting
- Hassenfeld Child Health Innovation Institute, Brown University, 121 S Main Street, Providence, Rhode Island, RI 02912, USA. .,Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, USA. .,University at Albany School of Public Health, Rensselaer, NY, USA.
| | - Tabassum Insaf
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, USA.,University at Albany School of Public Health, Rensselaer, NY, USA
| | - George Lui
- Pediatric Cardiology and Cardiovascular Medicine, Lucile Packard Children's Hospital Stanford, Stanford, California, USA
| | - Ali Zaidi
- Albert Einstein College of Medicine, The Bronx, NY, USA.,Children's Hospital at Montefiore, Bronx, New York, USA.,Sinai Adult Congenital Heart Disease Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alissa Van Zutphen
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, USA.,University at Albany School of Public Health, Rensselaer, NY, USA
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28
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Anderson KN, Tepper NK, Downing K, Ailes EC, Abarbanell G, Farr SL. Contraceptive methods of privately insured US women with congenital heart defects. Am Heart J 2020; 222:38-45. [PMID: 32014720 PMCID: PMC7521137 DOI: 10.1016/j.ahj.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/11/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The American Heart Association recommends women with congenital heart defects (CHD) receive contraceptive counseling early in their reproductive years, but little is known about contraceptive method use among women with CHD. We describe recent female sterilization and reversible prescription contraceptive method use by presence of CHD and CHD severity in 2014. METHODS Using IBM MarketScan Commercial Databases, we included women aged 15 to 44 years with prescription drug coverage in 2014 who were enrolled ≥11 months annually in employer-sponsored health plans between 2011 and 2014. CHD, CHD severity, contraceptive methods, and obstetrics-gynecology and cardiology provider encounters were identified using billing codes. We used log-binomial regression to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to compare contraceptive method use overall and by effectiveness tier by CHD presence and, for women with CHD, severity. RESULTS Recent sterilization or current reversible prescription contraceptive method use varied slightly among women with (39.2%) and without (37.3%) CHD, aPR = 1.04, 95% CI [1.01-1.07]. Women with CHD were more likely to use any Tier I method (12.9%) than women without CHD (9.3%), aPR = 1.41, 95% CI [1.33-1.50]. Women with severe, compared to non-severe, CHD were less likely to use any method, aPR = 0.85, 95% CI [0.78-0.92], or Tier I method, aPR = 0.84, 95% CI [0.70-0.99]. Approximately 60% of women with obstetrics-gynecology and <40% with cardiology encounters used any included method. CONCLUSIONS There may be missed opportunities for providers to improve uptake of safe, effective contraceptive methods for women with CHD who wish to avoid pregnancy.
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Affiliation(s)
- Kayla N Anderson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karrie Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth C Ailes
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ginnie Abarbanell
- Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
| | - Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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29
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Schlichting LE, Insaf TZ, Zaidi AN, Lui GK, Van Zutphen AR. Maternal Comorbidities and Complications of Delivery in Pregnant Women With Congenital Heart Disease. J Am Coll Cardiol 2020; 73:2181-2191. [PMID: 31047006 DOI: 10.1016/j.jacc.2019.01.069] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/19/2018] [Accepted: 01/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pregnant women with congenital heart defects (CHDs) may be at increased risk for adverse events during delivery. OBJECTIVES This study sought to compare comorbidities and adverse cardiovascular, obstetric, and fetal events during delivery between pregnant women with and without CHDs in the United States. METHODS Comorbidities and adverse delivery events in women with and without CHDs were compared in 22,881,691 deliveries identified in the 2008 to 2013 National Inpatient Sample using multivariable logistic regression. Among those with CHDs, associations by CHD severity and presence of pulmonary hypertension (PH) were examined. RESULTS There were 17,729 deliveries to women with CHDs (77.5 of 100,000 deliveries). These women had longer lengths of stay and higher total charges than women without CHDs. They had greater odds of comorbidities, including PH (adjusted odds ratio [aOR]: 193.8; 95% confidence interval [CI]: 157.7 to 238.0), congestive heart failure (aOR: 49.1; 95% CI: 37.4 to 64.3), and coronary artery disease (aOR: 31.7; 95% CI: 21.4 to 47.0). Greater odds of adverse events were observed, including heart failure (aOR: 22.6; 95% CI: 20.5 to 37.3), arrhythmias (aOR: 12.4; 95% CI: 11.0 to 14.0), thromboembolic events (aOR: 2.4; 95% CI: 2.0 to 2.9), pre-eclampsia (aOR: 1.5; 95% CI: 1.3 to 1.7), and placenta previa (aOR: 1.5; 95% CI: 1.2 to 1.8). Cesarean section, induction, and operative vaginal delivery were more common, whereas fetal distress was less common. Among adverse events in women with CHDs, PH was associated with heart failure, hypertension in pregnancy, pre-eclampsia, and pre-term delivery; there were no differences in most adverse events by CHD severity. CONCLUSIONS Pregnant women with CHDs were more likely to have comorbidities and experience adverse events during delivery. These women require additional monitoring and care.
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Affiliation(s)
- Lauren E Schlichting
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island; Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York; University at Albany School of Public Health, Rensselaer, New York.
| | - Tabassum Z Insaf
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York; University at Albany School of Public Health, Rensselaer, New York
| | - Ali N Zaidi
- Montefiore Medical Center, Children's Hospital at Montefiore/Albert Einstein College of Medicine, New York, New York
| | - George K Lui
- Stanford University School of Medicine, Stanford, California
| | - Alissa R Van Zutphen
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York; University at Albany School of Public Health, Rensselaer, New York
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Farr SL, Klewer SE, Nembhard WN, Alter C, Downing KF, Andrews JG, Collins RT, Glidewell J, Benavides A, Goudie A, Riehle-Colarusso T, Overman L, Riser AP, Oster ME. Rationale and design of CH STRONG: Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG. Am Heart J 2020; 221:106-113. [PMID: 31986287 DOI: 10.1016/j.ahj.2019.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
Studies of outcomes among adults with congenital heart defects (CHDs) have focused on those receiving cardiac care, limiting generalizability. The Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) will assess comorbidities, health care utilization, quality of life, and social and educational outcomes from a US population-based sample of young adults living with CHD. METHODS Individuals with CHD born between 1980 and 1997 were identified using active, population-based birth defects surveillance systems from 3 US locations (Arkansas [AR]; Arizona [AZ]; and Atlanta, Georgia [GA]) linked to death records. Individuals with current contact information responded to mailed survey materials during 2016 to 2019. Respondents and nonrespondents were compared using χ2 tests. RESULTS Sites obtained contact information for 74.6% of the 9,312 eligible individuals alive at recruitment. Of those, 1,656 returned surveys, either online (18.1%) or via paper (81.9%), for a response rate of 23.9% (AR: 18.3%; AZ: 30.7%; Atlanta, GA: 28.0%; P value < .01). For 20.0% of respondents, a proxy completed the survey, with 63.9% reporting that the individual with CHD was mentally unable. Among respondents and nonrespondents, respectively, sex (female: 54.0% and 47.3%), maternal race/ethnicity (non-Hispanic white: 74.3% and 63.0%), CHD severity (severe: 33.8% and 27.9%), and noncardiac congenital anomalies (34.8% and 38.9%) differed significantly (P value < .01); birth year (1991-1997: 56.0% and 57.5%) and presence of Down syndrome (9.2% and 8.9%) did not differ. CONCLUSIONS CH STRONG will provide the first multisite, population-based findings on long-term outcomes among the growing population of US adults with CHD.
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Raskind-Hood C, Saraf A, Riehle-Colarusso T, Glidewell J, Gurvitz M, Dunn JE, Lui GK, Van Zutphen A, McGarry C, Hogue CJ, Hoffman T, Rodriguez III FH, Book WM. Assessing Pregnancy, Gestational Complications, and Co-morbidities in Women With Congenital Heart Defects (Data from ICD-9-CM Codes in 3 US Surveillance Sites). Am J Cardiol 2020; 125:812-819. [PMID: 31902476 DOI: 10.1016/j.amjcard.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 12/13/2022]
Abstract
Improved treatment of congenital heart defects (CHDs) has resulted in women with CHDs living to childbearing age. However, no US population-based systems exist to estimate pregnancy frequency or complications among women with CHDs. Cases were identified in multiple data sources from 3 surveillance sites: Emory University (EU) whose catchment area included 5 metropolitan Atlanta counties; Massachusetts Department of Public Health (MA) whose catchment area was statewide; and New York State Department of Health (NY) whose catchment area included 11 counties. Cases were categorized into one of 5 mutually exclusive CHD severity groups collapsed to severe versus not severe; specific ICD-9-CM codes were used to capture pregnancy, gestational complications, and nongestational co-morbidities in women, age 11 to 50 years, with a CHD-related ICD-9-CM code. Pregnancy, CHD severity, demographics, gestational complications, co-morbidities, and insurance status were evaluated. ICD-9-CM codes identified 26,655 women with CHDs, of whom 5,672 (21.3%, range: 12.8% in NY to 22.5% in MA) had codes indicating a pregnancy. Over 3 years, age-adjusted proportion pregnancy rates among women with severe CHDs ranged from 10.0% to 24.6%, and 14.2% to 21.7% for women with nonsevere CHDs. Pregnant women with CHDs of any severity, compared with nonpregnant women with CHDs, reported more noncardiovascular co-morbidities. Insurance type varied by site and pregnancy status. These US population-based, multisite estimates of pregnancy among women with CHD indicate a substantial number of women with CHDs may be experiencing pregnancy and complications. In conclusion, given the growing adult population with CHDs, reproductive health of women with CHD is an important public health issue.
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Farr SL, Downing KF, Ailes EC, Gurvitz M, Koontz G, Tran EL, Alverson CJ, Oster ME. Receipt of American Heart Association-Recommended Preconception Health Care Among Privately Insured Women With Congenital Heart Defects, 2007-2013. J Am Heart Assoc 2019; 8:e013608. [PMID: 31510829 PMCID: PMC6818013 DOI: 10.1161/jaha.119.013608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Our objective was to estimate receipt of preconception health care among women with congenital heart defects (CHD), according to 2017 American Heart Association recommendations, as a baseline for evaluating recommendation implementation. Methods and Results Using 2007 to 2013 IBM MarketScan Commercial Databases, we identified women with CHD diagnosis codes ages 15 to 44 years who became pregnant and were enrolled in health insurance for ≥11 months in the year before estimated conception. We assessed documentation of complete blood count, electrolytes, thyroid‐stimulating hormone, liver function, ECG, comprehensive echocardiogram, and exercise stress test, using procedural codes, and outpatient prescription claims for US Food and Drug Administration category D and X cardiac‐related medications. Differences were examined according to CHD severity, age, region of residence, year of conception, and documented encounters at obstetric and cardiology practices. We found 2524 pregnancies among 2003 women with CHD (14.4% severe CHD). In the 98.3% of women with a healthcare encounter in the year before conception, <1% received all and 22.6% received no American Heart Association–recommended tests or assessments (range: 54.4% for complete blood count to 3.1% for exercise stress test). Women with the highest prevalence of receipt of recommended care were 35 to 44 years old, pregnant in 2012 to 2013, or had a documented obstetric or cardiology encounter in the year before conception (P<0.05 for all). In 9.0% of pregnancies, ≥1 prescriptions for US Food and Drug Administration category D or X cardiac‐related medications were filled in the year before conception. Conclusions A low percentage of women with CHD received American Heart Association–recommended preconception health care in the year before conception.
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Affiliation(s)
- Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | | | | | - Emmy L Tran
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA.,Oak Ridge Institute for Science and Education Oak Ridge TN
| | - C J Alverson
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA.,Children's Healthcare of Atlanta Emory University School of Medicine Atlanta GA
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Gerardin J, Raskind-Hood C, Rodriguez FH, Hoffman T, Kalogeropoulos A, Hogue C, Book W. Lost in the system? Transfer to adult congenital heart disease care-Challenges and solutions. CONGENIT HEART DIS 2019; 14:541-548. [PMID: 31066199 DOI: 10.1111/chd.12780] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Transfer of congenital heart disease care from the pediatric to adult setting has been identified as a priority and is associated with better outcomes. Our objective is to determine what percentage of patients with congenital heart disease transferred to adult congenital cardiac care. DESIGN A retrospective cohort study. SETTING Referrals to a tertiary referral center for adult congenital heart disease patients from its pediatric referral base. PATIENTS This resulted in 1514 patients age 16-30, seen at least once in three pediatric Georgia health care systems during 2008-2010. INTERVENTIONS We analyzed for protective factors associated with age-appropriate care, including distance from referral center, age, timing of transfer, gender, severity of adult congenital heart disease, and comorbidities. OUTCOME MEASURES We analyzed initial care by age among patients under pediatric care from 2008 to 2010 and if patients under pediatric care subsequently transferred to an adult congenital cardiologist in this separate pediatric and adult health system during 2008-2015. RESULTS Among 1514 initial patients (39% severe complexity), 24% were beyond the recommended transfer age of 21 years. Overall, only 12.1% transferred care to the referral affiliated adult hospital. 90% of these adults that successfully transferred were seen by an adult congenital cardiologist, with an average of 33.9 months between last pediatric visit and first adult visit. Distance to referral center contributed to delayed transfer to adult care. Those with severe congenital heart disease were more likely to transfer (18.7% vs 6.2% for not severe). CONCLUSION Patients with severe disease are more likely to transfer to adult congenital heart disease care than nonsevere disease. Most congenital heart disease patients do not transfer to adult congenital cardiology care with distance to referral center being a contributing factor. Both pediatric and adult care providers need to understand and address barriers in order to improve successful transfer.
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Affiliation(s)
- Jennifer Gerardin
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Wauwatosa, Wisconsin
| | - Cheryl Raskind-Hood
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Fred H Rodriguez
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Sibley Heart Center, Atlanta, Georgia
| | - Trenton Hoffman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Carol Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Wendy Book
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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