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Outpatient clinics for adults with congenital heart disease: increasing workload and evolving patterns of referral
M A Gatzoulis1, S Hechter, S C Siu
1Toronto Congenital Cardiac Centre for Adults, The Toronto Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
Insights
Adult congenital heart disease (ACHD) patients are increasingly seeking specialized care, leading to a significant rise in outpatient service workload. Referral patterns have evolved, with more community-based physicians referring patients for ACHD management.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease (ACHD)
- Healthcare Services Research
Background:
- Adults with congenital heart disease (ACHD) are living longer and require specialized lifelong care.
- Outpatient services play a crucial role in managing the complex needs of this growing population.
- Understanding trends in ACHD care is essential for service planning and resource allocation.
Purpose of the Study:
- To analyze the changing role and increasing demand for specialized outpatient services for adults with congenital heart disease.
- To examine shifts in referral patterns to a tertiary ACHD center over a decade.
Main Methods:
- Retrospective analysis of patient data from a tertiary referral center.
- Inclusion of data from three distinct three-month periods in 1987, 1992, and 1997.
- Assessment of patient demographics, referral sources, and diagnostic investigations.
Main Results:
- A substantial increase in clinic workload was observed, with 44% and 269% growth between 1987-1992 and 1992-1997, respectively.
- The mean age of patients decreased significantly over time, indicating earlier access to specialized care.
- Referrals from community cardiologists and family physicians increased substantially, alongside a rise in patients with prior reparative surgery and reoperations.
Conclusions:
- Specialized adult congenital heart disease (ACHD) outpatient services have experienced significant growth in demand over the past decade.
- Referral patterns have shifted, with an increasing proportion of patients being referred from non-specialized sources.
- These findings highlight the need for strategic planning to accommodate the expanding population of ACHD patients requiring specialized tertiary care.
Objective:
To examine the evolving role of specialised outpatient services for adult patients with congenital heart disease.
Design:
A retrospective analysis of all patients attending the Toronto Congenital Cardiac Centre for Adults over three corresponding three month periods in 1987, 1992, and 1997.
Setting:
A tertiary referral centre.
Main Outcome Measures:
Patient demographics, residence, medical and surgical history, type and source of referral, and investigations performed.
Results:
In all, 570 patients were seen at the clinic during these three periods. There was a 44% and a 269% increase in workload between 1987 to 1992 and 1992 to 1997, respectively. There was a steady fall in mean age of patients seen at the clinic with time (38.5, 33.6, and 31.7 years in 1987, 1992, and 1997, respectively, p < 0.001). New referrals from community cardiologists and family physicians increased more in relative terms than did referrals from the Hospital for Sick Children, Toronto (6.7%, 15%, and 37.5%, p = 0.02). There was a steady increase in patients with previous reparative surgery (48.9%, 59.2%, and 69.2%, p < 0.002). The proportion of patients with previous reoperations also increased (2.3%, 10%, and 9.2%, p < 0.01). Echocardiography remained the predominant method of diagnosis. The diagnostic mix did not change with time.
Conclusions:
Over the past 10 years there has been a large increase in adults with congenital heart disease requiring and seeking specialised care in a tertiary health centre, with a concomitant evolution of referral patterns. These data may be helpful in planning of similar paediatric and adult cardiac services for this expanding population.