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Role of Home Monitoring in Reducing Disparities in the Interstage Mortality of Infants with Single Ventricle
Yousef El-Magharbel1, Caren S Goldberg2, Sunkyung Yu2
1Congenital Heart Center, C. S. Mott Children's Hospital, Ann Arbor, MI.
Insights
The interstage home monitoring program (IHMP) improved survival and growth for single ventricle (SV) patients after the Norwood procedure. However, sociodemographic disparities in outcomes persist, indicating a need for targeted interventions for vulnerable populations.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Health Services Research
Background:
- Single ventricle (SV) physiology presents complex challenges in pediatric cardiac surgery.
- The interstage period (between Norwood and stage 2 palliation) is critical for SV patient outcomes.
- Disparities in survival and growth among SV patients necessitate targeted monitoring programs.
Purpose of the Study:
- To evaluate the impact of an interstage home monitoring program (IHMP) on disparities in interstage survival and growth.
- To assess the effectiveness of IHMP in mitigating clinical and sociodemographic factors affecting outcomes.
- To analyze changes in interstage mortality (ISM) and interstage growth (ISG) post-IHMP implementation.
Main Methods:
- Retrospective single-center study of SV patients undergoing the Norwood operation (2000-2020).
- Data sourced from electronic medical records, PC4 and NPC-QIC registries, and US census.
- Multivariable logistic and linear regressions analyzed IHMP's effect on ISM and ISG, controlling for clinical and sociodemographic variables using the NEONATE risk score.
Main Results:
- Interstage mortality (ISM) decreased significantly post-IHMP (12.7% vs 6.7%, P=0.04).
- Average interstage growth (ISG) z-scores improved significantly post-IHMP (-0.15 vs 0.14, P=0.01).
- Lower birthweight, public insurance, and high NEONATE risk score remained independently associated with adverse ISM and ISG, even after IHMP adjustment.
Conclusions:
- The IHMP has demonstrably improved interstage growth and survival for single ventricle patients.
- Despite improvements, significant sociodemographic disparities in outcomes persist.
- A tailored approach is crucial to address the needs of vulnerable SV patient groups and reduce persistent disparities.
Objective:
To determine whether the interstage (between Norwood and stage 2 palliation) home monitoring program (IHMP) has reduced disparities in interstage survival and growth outcomes in patients with single-ventricle heart disease.
Study Design:
A single-center, retrospective study was performed on patients with single-ventricle lesions who underwent a Norwood operation between January 2000 and December 2020. Data were collected from the institutional electronic medical record, the Pediatric Cardiac Critical Care Consortium and National Pediatric Cardiology Quality Improvement Collaborative registries, and the US census. The National Pediatric Cardiology Quality Improvement Collaborative's NEONATE risk score was used as the representative clinical variable. Primary outcomes were interstage mortality (ISM) and interstage growth (ISG), assessed by change in weight-for-age z scores. Multivariable logistic and linear regressions were used to examine the impact of IHMP, initiated in 2012 to address clinical and sociodemographic contributors of ISM, on the independent associations of patient clinical and sociodemographic factors with ISM and ISG, respectively.
Results:
Post-IHMP, ISM decreased (12.7% vs 6.7%, P = .04) and average ISG z scores increased (-0.15 [0.97] vs 0.14 [0.84)] P = .01). Multivariable analyses showed that lower birth weight, public insurance, and high NEONATE risk score were independently associated with ISM (all P < .05). Birth weight, feeding at discharge, and NEONATE risk score were independently associated with ISG (all P < .05). Both results remained significant after adjusting for IHMP.
Conclusions:
In the current era, with a robust IHMP, ISG and ISM improved whereas sociodemographic disparities persisted, suggesting the need for a tailored approach for vulnerable patient groups.
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