Ambulatory Care in Adult Congenital Heart Disease-Time for Change?

Area of Science:

• Cardiology
• Public Health
• Healthcare Management

Background:

• The population with adult congenital heart disease (ACHD) is expanding, presenting increasing complexity.
• Current ambulatory care practices for ACHD require evaluation for their effectiveness in problem detection and cost-efficiency.

Purpose of the Study:

• To assess the adequacy of current ambulatory care in detecting problems within the growing ACHD population.
• To evaluate the associated costs of existing ACHD ambulatory care models.

Main Methods:

• A single-centre UK study analyzed clinic attendances for 100 ACHD patients from 2014-2019.
• Data included patient demographics, appointment outcomes, diagnostic test results, hospital admissions, and travel impact.
• The study also examined care delivery during the COVID-19 restrictions period (March 2020-July 2021).

Main Results:

• Between 2014-2019, 575 appointments occurred with a 10% nonattendance rate; 80% yielded no decisions beyond continued review.
• Diagnostic tests rarely identified new findings (5.1% ECG, 4.0% echo); decisions were more frequent in higher ACHD AP classes and symptomatic patients.
• Emergency admissions (40) outnumbered elective (25), with over half following unremarkable appointments. Patient travel incurred significant workdays lost.
• During COVID-19, 127 appointments (56% in-person, 41% telephone, 5% video) showed higher decision-making rates in in-person vs. virtual consultations (37% vs. 19%).

Conclusions:

• ACHD clinics primarily serve surveillance purposes but currently do not effectively predict or prevent costly emergency hospital admissions.
• Existing care models are associated with significant patient and provider costs.
• The shift to alternative care delivery methods during COVID-19 necessitates further evaluation for optimizing ACHD patient management.