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Published on: July 18, 2014
Comparative Congenital Cardiac Catheterization Registry Analysis From the United States and Low- and Middle-Income
Fatima Ali1, Mary J Yeh2, Fiona E Walshe2
1Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
Insights
Congenital cardiac catheterization (CCC) in high-income countries involves more complex patients and procedures, leading to higher adverse event rates. However, low- and middle-income countries show higher failure-to-rescue rates, indicating a need for improved care.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Health Services Research
Background:
- Significant disparities exist in congenital heart disease (CHD) care between high-income countries and low- and middle-income countries (LMICs).
- These disparities likely extend to the practice of congenital cardiac catheterization (CCC).
Purpose of the Study:
- To compare patient characteristics, procedural approaches, and outcomes of CCC between a U.S.-based registry (C3PO) and an LMIC registry (IQIC-CHDCR).
- To identify differences in resource utilization and adverse event rates in CCC between high-income and LMIC settings.
Main Methods:
- Analysis of CCC procedures from 2019-2022 using harmonized data from the C3PO (19 sites) and IQIC-CHDCR (19 sites) registries.
- Comparison of patient demographics, procedural complexity, resource use, and clinical outcomes, including clinically meaningful adverse events (CMAE) and mortality.
Main Results:
- The C3PO cohort (28,957 cases) had more single ventricle patients and higher-risk procedures compared to IQIC-CHDCR (6,485 cases).
- C3PO procedures were longer, with higher CMAE rates (3.9% vs 1.5%), but similar mortality (0.5% vs 0.7%).
- Risk-adjusted analysis revealed lower CMAE and severity level 4/5 events in IQIC, but higher failure-to-rescue rates (7.1% vs 2.1%).
Conclusions:
- Harmonized databases enable direct comparison of CCC practices globally.
- While LMIC settings in IQIC show lower adverse event rates, they face challenges with higher failure-to-rescue rates.
- Further risk-adjustment modeling for LMICs is crucial to enhance global resource access and improve patient outcomes in congenital heart disease care.
Background:
Disparities in congenital heart disease care exist between high-income and low- and middle-income countries (LMICs), likely extending to congenital cardiac catheterization (CCC).
Objectives:
This study compares patient characteristics and outcomes of CCC in the U.S.-based Congenital Cardiac Catheterization Project on Outcomes (C3PO) and the International Quality Improvement Collaborative-Congenital Heart Disease Catheterization Registry (IQIC-CHDCR) from LMICs.
Methods:
The analysis included all CCC procedures recorded in C3PO (19 sites) and IQIC-CHDCR (19 sites) from 2019 to 2022. Patient and procedural characteristics, resource utilization, and outcomes were compared.
Results:
A total of 28,957 C3PO and 6,485 IQIC-CHDCR cases were analyzed. Single ventricle patients accounted for 30% of C3PO and 13% of International Quality Improvement Collaborative (IQIC), with high-risk procedures (procedural risk in congenital cardiac catheterization 3-5) performed more frequently in C3PO (42% vs 23%). Median procedure duration was longer in C3PO (1.5 vs 0.8 hours). Clinically meaningful adverse event (CMAE) rates were higher in C3PO (3.9% vs 1.5%), though mortality was comparable (0.5% vs 0.7%). Risk-adjusted analysis showed a lower ratio in IQIC for both CMAE (0.50; 95% CI: 0.39-0.62) and severity level 4/5 events (0.71; 95% CI: 0.52-0.96). However, failure-to-rescue rates were higher in IQIC (7.1% vs 2.1%).
Conclusions:
The harmonized databases facilitated direct comparison of CCC practices, revealing more complex patients and resource-intensive procedures in C3PO, while the IQIC cohort demonstrated lower CMAE rates but a slightly higher mortality rate. These findings emphasize the need for further risk adjustment modeling for LMICs and identify areas to enhance global resource access and patient outcomes.
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