1
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Donald EM, Oren D, DeFilippis EM, Rubinstein G, Moeller CM, Lee HY, Maldonado A, Portera MV, Fuselier B, Jackson R, Clerkin KJ, Fried JA, Raikhelkar J, Lee SH, Latif F, Lytrivi ID, Zuckerman WA, Richmond ME, Sayer G, Uriel N. Long-term outcomes for pediatric heart transplant recipients transitioning to adult care teams. Clin Transplant 2024; 38:e15282. [PMID: 38546027 DOI: 10.1111/ctr.15282] [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] [Received: 11/22/2023] [Revised: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND There are limited data evaluating the success of a structured transition plan specifically for pediatric heart transplant (HT) recipients following their transfer of care to an adult specialist. We sought to identify risk factors for poor adherence, graft failure, and mortality following the transfer of care to adult HT care teams. METHODS We retrospectively reviewed all patients who underwent transition from the pediatric to adult HT program at our center between January 2011 and June 2021. Demographic characteristics, comorbid conditions, and psychosocial history were collected at the time of HT, the time of transition, and the most recent follow-up. Adverse events including mortality, graft rejection, infection, and renal function were also captured before and after the transition. RESULTS Seventy-two patients were identified (54.1% male, 54.2% Caucasian). Mean age at the time of transition was 23 years after a median of 11.6 years in the pediatric program. The use of calcineurin inhibitors was associated with reduced mortality (HR .04, 95% CI .0-.6, p = .015), while prior psychiatric hospitalization (HR 45.3, 95% CI, 6.144-333.9, p = .0001) was associated with increased mortality following transition. Medication nonadherence and young age at the time of transition were markers for high-risk individuals prior to the transition of care. CONCLUSIONS Transition of HT recipients from a pediatric program to an adult program occurs during a vulnerable time of emerging adulthood, and we have identified risk factors for mortality following transition. Development of a formalized transition plan with a large multidisciplinary team with focused attention on high-risk patients, including those with psychiatric comorbidities, may favorably influence outcomes.
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Affiliation(s)
- Elena M Donald
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel Oren
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ersilia M DeFilippis
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Gal Rubinstein
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Catherine M Moeller
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Hannah Y Lee
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Alejandro Maldonado
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Mary Virginia Portera
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Byron Fuselier
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ruslana Jackson
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Clerkin
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Justin A Fried
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jayant Raikhelkar
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Sun Hi Lee
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Farhana Latif
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Irene D Lytrivi
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Warren A Zuckerman
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Marc E Richmond
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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2
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de Hosson M, De Groote K, Hecke AV, De Wolf D, Vandekerckhove K, Mosquera LM, Panzer J, Logghe K, Mels S, Demulier L, Campens L, Goossens E, De Backer J. Evaluation of a nurse-led multi-component transition program for adolescents with congenital heart disease. PATIENT EDUCATION AND COUNSELING 2024; 118:108028. [PMID: 37879284 DOI: 10.1016/j.pec.2023.108028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the transition program for adolescents with congenital heart disease (CHD) 'Transition With a Heart' (TWAH) on disease-related knowledge, quality of life (QoL), transition experiences, and gaps in follow-up. METHODS A study with pre-posttest and control group (post-test) using consecutive sampling, including adolescents with moderate to severely complex CHD, without intellectual disability, aged≥ 12 y, and parents. After weighting, t-tests were performed. A multivariable regression analysis explored the outcomes' determinants. RESULTS In the intervention group, 28 adolescents and 25 parents were included, and 53 adolescents and 18 parents as controls. Adolescents' knowledge significantly increased after completing TWAH (from 59.8% to 75.7%;p < 0.01). Their knowledge was positively correlated with TWAH (β = +13.3;p < 0.01). Adolescents' transition experiences were also positively related to TWAH (general experience: β = +5.5;p < 0.01; transfer satisfaction: β = +0.8; p < 0.01). Adolescents' QoL was mainly determined by CHD complexity and not by TWAH. No one showed gaps in follow-up. TWAH was not associated with parents' transition experiences. CONCLUSION Implementing TWAH substantially improved adolescents' disease-related knowledge and transition experiences. PRACTICE IMPLICATIONS The results regarding transition experiences need to be confirmed by further research. The TWAH design with the person-tailored educational program, skills training, and the transition coordinator can be used in settings with other chronic diseases.
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Affiliation(s)
- Michèle de Hosson
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium.
| | - Katya De Groote
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | - Ann Van Hecke
- Ghent University - Faculty of Medicine and Health Sciences - Department of Public Health and Primary Care - University Center for Nursing and Midwifery, Ghent, Belgium; Ghent University Hospital, Staff nursing department, Ghent, Belgium
| | - Daniël De Wolf
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | | | | | - Joseph Panzer
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | - Karen Logghe
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | - Saskia Mels
- Ghent University Hospital, Department of Pediatric Psychology, Ghent, Belgium
| | - Laurent Demulier
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium
| | - Laurence Campens
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium
| | - Eva Goossens
- University of Antwerp - Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, Antwerp, Belgium; KU Leuven - Department of Public Health and Primary Care, Leuven, Belgium
| | - Julie De Backer
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium
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3
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Hummel K, Ludomirsky A, Burgunder L, Lu M, Goldberg S, Sleeper L, Reichman J, Blume ED. The family burden of paediatric heart disease during the chronic phase of illness. Cardiol Young 2023:1-7. [PMID: 38014533 DOI: 10.1017/s1047951123003906] [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: 11/29/2023]
Abstract
BACKGROUND CHD is a lifelong condition with a significant burden of disease to patients and families. With increased survival, attention has shifted to longer-term outcomes, with a focus on social determinants of health. Among children with CHD, socioeconomic status is associated with disparities in outcomes. Household material hardship is a concrete measure of poverty and may serve as an intervenable measure of socioeconomic status. METHODS A longitudinal survey study was conducted at multiple time points (at acute hospitalisation, then 12-24 months later in the chronic phase) to determine the prevalence of household material hardship among parents of children with advanced heart disease and quality of life during long-term follow-up. RESULTS The analytic cohort was 160 children with a median patient age of 1 year (IQR 1,4) with 54% of patients <2 years. During acute hospitalisation, over one-third of families reported household material hardship (37%), with significantly lower household material hardship in the chronic phase at 16% (N = 9 of 52). For parents reporting household material hardship during acute hospitalisation, 50% had resolution of household material hardship by the chronic phase. Household material hardship-exposed children were significantly more likely to be publicly insured (56% versus 20%, p = 0.03) with lower quality of life than those without household material hardship (64% versus 82%, p = 0.013). CONCLUSION The burden of heart disease during the chronic phase of illness is high. Household material hardship may serve as a target to ensure equity in the care and outcomes of CHD patients and their families.
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Affiliation(s)
- Kevin Hummel
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Intermountain Health Primary Children's Hospital, Salt Lake City, UT, USA
| | - Avital Ludomirsky
- Department of Cardiology, Childrens Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lauren Burgunder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Intermountain Health Primary Children's Hospital, Salt Lake City, UT, USA
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Goldberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Lynn Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Jeffrey Reichman
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
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4
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Burger D, Denfeld QE, Evers PD, Ward P, Woods P, Hasan R. Referral Order Placement Decreases Time to Transfer to Adult Congenital Heart Disease Care. Pediatr Cardiol 2023:10.1007/s00246-023-03164-3. [PMID: 37103492 DOI: 10.1007/s00246-023-03164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023]
Abstract
Pediatric patients with moderate and great complexity congenital heart disease (CHD) may benefit from coordinated transfer to adult congenital heart disease (ACHD) centers to reduce the risk of complications; however, there are a variety of transfer practices. We examined the impact of referral order placement at the last pediatric cardiology visit on time to transfer to an ACHD center. We analyzed data collected from pediatric patients with moderate and great complexity CHD who were eligible to transfer to our tertiary center's accredited ACHD center. We examined transfer outcomes and time-to-transfer between those with a referral order placed at the last pediatric cardiology visit and those without using Cox proportional hazards modeling. The sample (n = 65) was 44.6% female and mean age at study start was 19.5 years (± 2.2). Referral orders were placed for 32.3% of patients at the last pediatric cardiology visit. Those who had a referral order placed at the last visit had significantly higher number of successful transfers to the ACHD center compared to those who did not (95% vs 25%, p < 0.001). In a Cox regression model, placement of a referral order at the last pediatric cardiology visit was associated significantly with a sooner time to transfer (HR 6.0; 95% CI 2.2-16.2, p > 0.001), adjusting for age, sex, complexity, living location, and pediatric cardiology visit location. Placement of a referral order at the last pediatric cardiology visit may improve transfer occurrence and time to transfer to accredited ACHD centers.
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Affiliation(s)
- Debora Burger
- Oregon Health & Science University School of Nursing, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR, 97239-2941, USA.
| | - Quin E Denfeld
- Oregon Health & Science University School of Nursing, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR, 97239-2941, USA
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Patrick D Evers
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - Pam Ward
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - Patricia Woods
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Reem Hasan
- Departments of Internal Medicine and Pediatrics, Oregon Health & Science University, Portland, OR, USA
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5
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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6
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John AS, Jackson JL, Moons P, Uzark K, Mackie AS, Timmins S, Lopez KN, Kovacs AH, Gurvitz M. Advances in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: A Practical Approach to Transition Program Design: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025278. [PMID: 35297271 PMCID: PMC9075425 DOI: 10.1161/jaha.122.025278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is now expected that most individuals with congenital heart disease will survive to adulthood, including those with complex heart conditions. Maintaining lifelong medical care requires those with congenital heart disease to eventually transfer from pediatric to adult-oriented health care systems. Developing health care transition skills and gaining independence in managing one's own health care is imperative to this process and to ongoing medical and psychosocial success. This scientific statement reviews the recent evidence regarding transition and provides resources, components, and suggestions for development of congenital heart disease transition programs with the goals of improving patient knowledge, self-management, and self-efficacy skills to the level they are capable to eventually integrate smoothly into adult-oriented health care. Specifically, the scientific statement updates 3 sections relevant to transition programming. First, there is a review of specific factors to consider, including social determinants of health, psychosocial well-being, and neurocognitive status. The second section reviews costs of inadequate transition including the public health burden and the impairment in individual quality of life. Finally, the last section discusses considerations and suggestions for transition program design including communication platforms, a family-centered approach, and individual models. Although this scientific statement reviews recent literature surrounding transitions of care for individuals with congenital heart disease there remain significant knowledge gaps. As a field, we have yet to determine ideal timing and methods of transition, and barriers to transition and transfer remain, particularly for the underserved populations. The consequences of poor health care transition are great and garnering outcomes and information through organized, multifaceted, collaborative approaches to transition is critical to improving the lifelong care of individuals with congenital heart disease.
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7
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Skogby S, Bratt EL, Johansson B, Moons P, Goossens E. Discontinuation of follow-up care for young people with complex chronic conditions: conceptual definitions and operational components. BMC Health Serv Res 2021; 21:1343. [PMID: 34911550 PMCID: PMC8672472 DOI: 10.1186/s12913-021-07335-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background A substantial proportion of young people with Complex Chronic Conditions (CCCs) experience some degree of discontinuation of follow-up care, which is an umbrella term to describe a broken chain of follow-up. Discontinuation of follow-up care is not clearly defined, and the great plethora of terms used within this field cannot go unnoticed. Terms such as “lost to follow-up”, “lapses in care” and “care gaps”, are frequently used in published literature, but differences between terms are unclear. Lack of uniformity greatly affects comparability of study findings. The aims of the present study were to (i) provide a systematic overview of terms and definitions used in literature describing discontinuation of follow-up care in young people with CCC’s; (ii) to clarify operational components of discontinuation of follow-up care (iii); to develop conceptual definitions and suggested terms to be used; and (iv) to perform an expert-based evaluation of terms and conceptual definitions. Methods A systematic literature search performed in PubMed was used to provide an overview of current terms used in literature. Using a modified summative content analysis, operational components were analysed, and conceptual definitions were developed. These conceptual definitions were assessed by an expert panel using a survey. Results In total, 47 terms and definitions were retrieved, and a core set of operational components was identified. Three main types of discontinuation of follow-up care emerged from the analysis and expert evaluation, conceptually defined as follows: Lost to follow-up care: “No visit within a defined time period and within a defined context, and the patient is currently no longer engaged in follow-up care”;Gap in follow-up care: “Exceeded time interval between clinic visits within a defined context, and the patient is currently engaged in follow-up care”; andUntraceability: “Failure to make contact due to lack of contact information”. Conclusion By creating a common vocabulary for discontinuation of follow-up care, the quality of future studies could improve. The conceptual definitions and operational components provide guidance to both researchers and healthcare professionals focusing on discontinuation of follow-up care for young people with CCCs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07335-x.
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Affiliation(s)
- Sandra Skogby
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Gothenburg, Sweden. .,KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Bengt Johansson
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium.,Center for Research and Innovation in Care, Faculty of Nursing, University of Antwerp, Antwerp, Belgium.,Department of Patient Care Services, Antwerp University Hospital, Antwerp, Belgium
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8
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Skogby S, Goossens E, Johansson B, Moons P, Bratt EL. Qualitative study of facilitators and barriers for continued follow-up care as perceived and experienced by young people with congenital heart disease in Sweden. BMJ Open 2021; 11:e049556. [PMID: 34706951 PMCID: PMC8552172 DOI: 10.1136/bmjopen-2021-049556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
UNLABELLED In-depth understanding of factors perceived by young people with congenital heart disease (CHD) to affect continued follow-up care is needed to tailor preventive strategies for discontinuation of follow-up care. To identify facilitating factors, low-prevalence settings in terms of discontinuation should be investigated. OBJECTIVE This qualitative study describes factors affecting continued follow-up as perceived and experienced by young adults with CHD. PARTICIPANTS Using a mixed purposive sampling technique, 16 young adults with CHD were included. Three participants had discontinued follow-up care and 13 had continued follow-up care after transfer. SETTING Participants were recruited from all seven university hospitals in Sweden, which is considered a low-prevalence setting in terms of discontinuation. DESIGN Individual interviews were performed and subjected to qualitative content analysis. RESULTS The analysis resulted in three main categories, illuminating factors affecting continued follow-up: (1) motivation for follow-up care; (2) participation in care and sense of connectedness with healthcare provider (HCP) and (3) care accessibility. The choice of continuing follow-up or not was multifactorial. Knowledge of your CHD and the importance of continuing follow-up care was a central factor, as well as experiencing CHD-related symptoms and having ongoing or planned medical treatment or interventions. Sensing a clear purpose with follow-up care was facilitating, as was feeling well treated and cared for by HCPs. Practical aspects, such as travel distance was also stressed, as well as active invitations and reminders for visits. CONCLUSION Factors on both patient, hospital and healthcare system level were raised by participants, stressing the importance of holistic approaches when developing preventive strategies for discontinuation. There is a need for improved skills and competencies among HCPs, as well as a person-centred approach to follow-up care. In addition, specific healthcare needs and remaining transitional needs after transfer to adult care require careful consideration to prevent discontinuation.
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Affiliation(s)
- Sandra Skogby
- University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
- KU Leuven Department of Public Health and Primary Care, Leuven, Flanders, Belgium
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, Leuven, Flanders, Belgium
- Center for Research and Innovation in Care, Faculty of Nursing, University of Antwerp, Antwerp, Belgium
| | - Bengt Johansson
- Heart Centre and Department of Surgery and Perioperative Sciences, Umeå University, Umea, Sweden
| | - Philip Moons
- University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
- KU Leuven Department of Public Health and Primary Care, Leuven, Flanders, Belgium
| | - Ewa-Lena Bratt
- University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
- Department of Pediatric Cardiology, Queen Silvia Children's Hospital, Gothenburg, Sweden
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9
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Moons P, Skogby S, Bratt EL, Zühlke L, Marelli A, Goossens E. Discontinuity of Cardiac Follow-Up in Young People With Congenital Heart Disease Transitioning to Adulthood: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e019552. [PMID: 33660532 PMCID: PMC8174191 DOI: 10.1161/jaha.120.019552] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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 The majority of people born with congenital heart disease require lifelong cardiac follow-up. However, discontinuity of care is a recognized problem and appears to increase around the transition to adulthood. We performed a systematic review and meta-analysis to estimate the proportion of adolescents and emerging adults with congenital heart disease discontinuing cardiac follow-up. In pooled data, we investigated regional differences, disparities by disease complexity, and the impact of transition programs on the discontinuity of care. Methods and Results Searches were performed in PubMed, Embase, Cinahl, and Web of Science. We identified 17 studies, which enrolled 6847 patients. A random effects meta-analysis of single proportions was performed according to the DerSimonian-Laird method. Moderator effects were computed to explore sources for heterogeneity. Discontinuity proportions ranged from 3.6% to 62.7%, with a pooled estimated proportion of 26.1% (95% CI, 19.2%-34.6%). A trend toward more discontinuity was observed in simple heart defects (33.7%; 95% CI, 15.6%-58.3%), compared with moderate (25.7%; 95% CI, 15.2%-40.1%) or complex congenital heart disease (22.3%; 95% CI, 16.5%-29.4%) (P=0.2372). Studies from the United States (34.0%; 95% CI, 24.3%-45.4%), Canada (25.7%; 95% CI, 17.0%-36.7%), and Europe (6.5%; 95% CI, 5.3%-7.9%) differed significantly (P=0.0004). Transition programs were shown to have the potential to reduce discontinuity of care (12.7%; 95% CI, 2.8%-42.3%) compared with usual care (36.2%; 95% CI, 22.8%-52.2%) (P=0.1119). Conclusions This meta-analysis showed that there is a high proportion of discontinuity of care in young people with congenital heart disease. The highest discontinuity proportions were observed in studies from the United States and in patients with simple heart defects. It is suggested that transition programs have a protective effect. Registration URL: www.crd.york.ac.uk/prospero. Unique identifier: CRD42020182413.
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Affiliation(s)
- Philip Moons
- Department of Public Health and Primary Care KU Leuven Belgium.,Institute of Health and Care SciencesUniversity of Gothenburg Sweden.,Department of Pediatrics and Child Health University of Cape Town South Africa
| | - Sandra Skogby
- Department of Public Health and Primary Care KU Leuven Belgium.,Institute of Health and Care SciencesUniversity of Gothenburg Sweden.,Department of Pediatric Cardiology Queen Silvia's Children's HospitalUniversity of Gothenburg Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care SciencesUniversity of Gothenburg Sweden.,Department of Pediatric Cardiology Queen Silvia's Children's HospitalUniversity of Gothenburg Sweden
| | - Liesl Zühlke
- Department of Pediatrics and Child Health University of Cape Town South Africa.,Division of Cardiology Groote Schuur HospitalFaculty of Health SciencesUniversity of Cape Town South Africa
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) McGill University Health Center Montreal QC Canada
| | - Eva Goossens
- Department of Public Health and Primary Care KU Leuven Belgium.,Research Foundation Flanders (FWO) Brussels Belgium.,Faculty of Medicine and Health Sciences Centre for Research and Innovation in Care Division of Nursing and Midwifery University of Antwerp Belgium
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10
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Social determinants of health and outcomes for children and adults with congenital heart disease: a systematic review. Pediatr Res 2021; 89:275-294. [PMID: 33069160 DOI: 10.1038/s41390-020-01196-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Social determinants of health (SDH) can substantially impact health outcomes. A systematic review, however, has never been conducted on associations of SDH with congenital heart disease (CHD) outcomes. The aim, therefore, was to conduct such a systematic review. METHODS Seven databases were searched through May 2020 to identify articles on SDH associations with CHD. SDH examined included poverty, uninsurance, housing instability, parental educational attainment, immigration status, food insecurity, and transportation barriers. Studies were independently selected and coded by two researchers based on the PICO statement. RESULTS The search generated 3992 citations; 88 were included in the final database. SDH were significantly associated with a lower likelihood of fetal CHD diagnosis, higher CHD incidence and prevalence, increased infant mortality, adverse post-surgical outcomes (including hospital readmission and death), decreased healthcare access (including missed appointments, no shows, and loss to follow-up), impaired neurodevelopmental outcomes (including IQ and school performance) and quality of life, and adverse outcomes for adults with CHD (including endocarditis, hospitalization, and death). CONCLUSIONS SDH are associated with a wide range of adverse outcomes for fetuses, children, and adults with CHD. SDH screening and referral to appropriate services has the potential to improve outcomes for CHD patients across the lifespan. IMPACT Social determinants of health (SDH) are associated with a wide range of adverse outcomes for fetuses, children, and adults with congenital heart disease (CHD). This is the first systematic review (to our knowledge) on associations of SDH with congenital heart disease CHD outcomes. SDH screening and referral to appropriate services has the potential to improve outcomes for CHD patients across the lifespan.
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11
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Transition to adult care for adolescents with congenital heart disease – Is there a light at the end of the tunnel? Int J Cardiol 2020; 311:35-36. [DOI: 10.1016/j.ijcard.2020.03.073] [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: 03/16/2020] [Accepted: 03/27/2020] [Indexed: 12/27/2022]
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12
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Reekie J. Flying the nest: are we doing enough to achieve successful transition in young people with congenital heart disease? BRITISH HEART JOURNAL 2020; 106:87-88. [DOI: 10.1136/heartjnl-2019-315727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Zentner D, Celermajer DS, Gentles T, d’Udekem Y, Ayer J, Blue GM, Bridgman C, Burchill L, Cheung M, Cordina R, Culnane E, Davis A, du Plessis K, Eagleson K, Finucane K, Frank B, Greenway S, Grigg L, Hardikar W, Hornung T, Hynson J, Iyengar AJ, James P, Justo R, Kalman J, Kasparian N, Le B, Marshall K, Mathew J, McGiffin D, McGuire M, Monagle P, Moore B, Neilsen J, O’Connor B, O’Donnell C, Pflaumer A, Rice K, Sholler G, Skinner JR, Sood S, Ward J, Weintraub R, Wilson T, Wilson W, Winlaw D, Wood A. Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement. Heart Lung Circ 2020; 29:5-39. [DOI: 10.1016/j.hlc.2019.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
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14
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Abstract
Purpose of the Review The purpose of this review is to illustrate specific challenges and opportunities in the building of an adult congenital heart disease (ACHD) program and to highlight critical components and important allies. Recent Findings With more than 1.4 million adults with congenital heart disease in the USA alone, access to specialized, compassionate, high-quality comprehensive care requires a shift toward more aggressive expansion of ACHD care, especially in the context of sparse ACHD provider representation in the vast majority of adult medical centers. Summary The effective build of an ACHD program requires measured escalation in management of ACHD complexity matched with cultivation of key resources and clinical services ranging from congenital cardiac surgery and interventional cardiology to acquired heart disease as well as partnerships with non-cardiac specialists. By reframing ACHD care as a shared goal between patients, providers, hospitals, pharmaceutical and device industry, and payers, a potent business model can be built around the developing ACHD program to facilitate acquisition of these key resources.
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