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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Short-term outcomes following implementation of a dedicated young adult congenital heart disease transition program
Sumeet S Vaikunth1,2, Roberta G Williams3, Merujan Y Uzunyan4
1Department of Internal Medicine, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA.
Insights
Successful transfer from pediatric to adult care for congenital heart disease patients remains low, even with dedicated clinics. Severe disease and cardiac devices were linked to successful transfer, highlighting ongoing challenges in care transitions.
Area of Science:
- Cardiology
- Healthcare Transition
- Patient Outcomes
Background:
- Transitioning congenital heart disease (CHD) patients from pediatric to adult care is crucial.
- Gaps in care during this transition can lead to adverse outcomes, including mortality.
- Dedicated transition clinics aim to improve care transfer success, but outcome data are limited.
Purpose of the Study:
- To evaluate the outcomes of care transfer for young adult CHD patients within a specialized transition clinic.
- To identify demographic factors associated with successful transfer from pediatric to adult care settings.
Main Methods:
- Retrospective analysis of 73 young adult CHD patients from January 2012 to December 2015.
- Correlated demographic characteristics (CHD severity, comorbidities, devices, insurance) with transfer success.
- Utilized multivariate analysis to identify predictors of successful transfer.
Main Results:
- Only 39% of patients successfully transferred to adult care services.
- Severe CHD (OR 4.44) and cardiac implantable electronic devices (OR 4.93) were significantly associated with successful transfer.
- Trends suggested improved transfer rates with comorbidities and private insurance.
Conclusions:
- Dedicated transition clinics show limited success in improving transfer rates for CHD patients.
- Disease severity and presence of cardiac devices are key factors influencing transfer success.
- Improving transfer outcomes requires collaborative efforts from healthcare systems, insurers, and policymakers.
Objective:
Transition from pediatric to adult care is a critical time for patients with congenital heart disease. Lapses in care can lead to poor outcomes, including increased mortality. Formal transition clinics have been implemented to improve success of transferring care from pediatric to adult providers; however, data regarding outcomes remain limited. We sought to evaluate outcomes of transfer within a dedicated transition clinic for young adult patients with congenital heart disease.
Design, Setting, And Patients:
We performed a retrospective analysis of all 73 patients seen in a dedicated young adult congenital heart disease transition clinic from January 2012 to December 2015 within a single academic institution that delivered pediatric and adult care at separate children's and adult hospitals, respectively.
Intervention And Outcome Measures:
Demographic characteristics including congenital heart disease severity, gender, age, presence of comorbidities, presence of cardiac implantable electronic devices, and type of insurance were correlated to success of transfer. Rate of successful transfer was evaluated, and multivariate analysis was performed to determine which demographic variables were favorably associated with transfer.
Results:
Thirty-nine percent of patients successfully transferred from pediatric to adult services during the study period. Severe congenital heart disease (OR 4.44, 95% CI 1.25-15.79, P = .02) and presence of a cardiac implantable electronic device (OR 4.93, 95% CI 1.18-20.58, P = .03) correlated with transfer. Trends favoring successful transfer with presence of comorbidities and private insurance were also noted.
Conclusions:
Despite a dedicated transition clinic, successful transfer rates remained relatively low though comparable to previously published rates. Severity of disease and presence of implantable devices correlated with successful transfer. Other obstacles to transfer remain and require combined efforts from pediatric and adult care systems, insurance carriers, and policy makers to improve transfer outcomes.
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