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Patterns in hospital admissions for adults with congenital heart disease for non-cardiac procedures
Jan Oliver Friess1, Urbano L França1, Anne Marie Valente2
1Department of Anesthesiology Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Adults with congenital heart disease (CHD) undergoing non-cardiac procedures are more often treated in hospitals with cardiac surgical programs, experiencing higher comorbidities and mortality. Further assessment of risk stratification and access is needed for these patients.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Healthcare Management
Background:
- Advances in congenital heart disease (CHD) management have increased the adult CHD population.
- Many adults with CHD require non-cardiac procedures, necessitating specialized care.
- Understanding care patterns and outcomes for these procedures is crucial.
Purpose of the Study:
- To describe characteristics of adults with CHD undergoing non-cardiac procedures.
- To analyze patient distribution across different hospital types (with/without cardiac surgical programs).
- To identify factors influencing hospital choice and determine mortality rates.
Main Methods:
- Retrospective analysis of 27 state inpatient databases.
- Inclusion of encounters involving CHD and non-cardiac procedures.
- Classification of hospitals into those with and without cardiac surgical programs.
- Multivariable logistic regression to identify predictors of care location.
Main Results:
- The study included 12,944 encounters across 1206 hospitals.
- Most patients (78.1%) received care in hospitals with cardiac surgical programs.
- Patients in these specialized hospitals had higher comorbidity indices and increased mortality (4.0% vs 2.3%).
- Higher comorbidity and specific age groups were associated with care in hospitals with cardiac surgical programs.
Conclusions:
- Adults with CHD undergoing non-cardiac procedures are predominantly treated in hospitals with cardiac surgical programs.
- These patients exhibit greater comorbidities and higher mortality compared to those treated in hospitals without such programs.
- Further research on risk stratification and locoregional accessibility is needed to understand admission patterns.
Objective:
Advances in management of congenital heart disease (CHD) have led to an increasing population of adults with CHD, many of whom require non-cardiac procedures. The objectives of this study were to describe the characteristics of these patients, their distribution among different hospital categories and the characteristics determining this distribution, and mortality rates following noncardiac procedures.
Methods:
We retrospectively analysed 27 state inpatient databases. Encounters with CHD and non-cardiac procedures were included. The location of care was classified into two categories: hospitals with and without cardiac surgical programmes. Variables included were demographics, comorbidity index, mortality. Multivariable logistic regression was used to explore predictors for care in different locations.
Results:
The cohort consisted of 12 944 encounters in 1206 hospitals. Most patients were cared for in hospitals with a cardiac surgical programme (78.1%). Patients presenting to hospitals with a cardiac surgical programme presented with higher comorbidity index (6 (IQR: 0-19) vs 2 (IQR: -3-14), p<0.001) than patients presenting to hospitals without a cardiac surgical programme. Mortality was higher in hospitals with cardiac surgical programmes compared with hospitals without cardiac surgical programmes (4.0% vs 2.3%, p<0.001). Factors associated with provision of care at a hospital with a cardiac surgical programme were comorbidity index (>7: OR 2.01 (95% CI 1.83 to 2.21), p<0.001; 2-7: OR 1.59 (95% CI 1.41 to 1.79), p<0.001) and age (18-44 years: OR 1.43 (95% CI 1.26 to 1.62), p<0.001; 45-64 years: OR 1.21 (95% CI 1.08 to 1.34), p<0.001).
Conclusion:
Adults with CHD undergoing non-cardiac procedures are mainly cared for in hospitals with a cardiac surgical programme and have greater comorbidities and higher mortality than those in centres without cardiac surgical programmes. Risk stratification and locoregional accessibility need further assessment to fully understand admission patterns.
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