scholarly journals Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Michal Benderly ◽  
Jonathan Buber ◽  
Ofra Kalter‐Leibovici ◽  
Leonard Blieden ◽  
Alexander Dadashev ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Service Utilization ◽  
Congenital Heart ◽  
Emergency Department Visits ◽  
Female Sex ◽  
Outpatient Visits ◽  
Utilization Patterns

Background Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. Methods and Results We identified 11 653 patients with ACHD aged ≥18 years (median, 47 years), through electronic records of 2 large Israeli healthcare providers (2007–2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standardized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47–1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69–5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82–7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61–16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: primary care (HR, 1.14; 95% CI, 1.06–1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24–1.59); emergency department visits (HR, 1.19; 95% CI, 1.02–1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49–2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84–0.94]) and periphery (HR, 0.72 [95% CI, 0.58–0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. Conclusions Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and ethnicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.

Clinic nonattendance is associated with increased emergency department visits in adults with congenital heart disease

2019 ◽  
Vol 14 (5) ◽  
pp. 726-734 ◽  
Author(s):  
Katherine Awh ◽  
Morgan A. Venuti ◽  
Lacey P. Gleason ◽  
Rachel Rogers ◽  
Srinivas Denduluri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Emergency Department Visits

EMERGENCY DEPARTMENT VISITS AMONG CHILDREN WITH CONGENITAL HEART DISEASE IN THE UNITED STATES FROM 2006 TO 2014

2018 ◽  
Vol 71 (11) ◽  
pp. A605
Author(s):  
Jonathan Edelson ◽  
Joseph William Rossano ◽  
Heather Griffis ◽  
Dingwei Dai ◽  
Jennifer Faerber ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
The United States ◽  
Emergency Department Visits

scholarly journals Emergency Department Visits by Children With Congenital Heart Disease

2018 ◽  
Vol 72 (15) ◽  
pp. 1817-1825 ◽  
Author(s):  
Jonathan B. Edelson ◽  
Joseph W. Rossano ◽  
Heather Griffis ◽  
Dingwei Dai ◽  
Jennifer Faerber ◽  
...  
Keyword(s):  
Emergency Department ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Emergency Department Visits

Understanding the Fontan Procedure in Congenital Heart Disease Patients and the Importance of Early Hepatology Referrals: A Case Study

2018 ◽  
Vol 11 (2) ◽  
pp. 95-99
Author(s):  
Alice Chan
Keyword(s):  
Primary Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Nurse Practitioners ◽  
Congenital Heart ◽  
Care Setting ◽  
Primary Care Setting ◽  
Fontan Procedure ◽  
Early Screening

Background: Patients with congenital heart disease are surviving into adulthood because of new surgeries developed over the recent decades. One surgery is the Fontan procedure, which is used in patients with only one functioning ventricle. Although it has been saving lives, in the recent years multiple complications have been noted. Objective: To discuss the Fontan procedure and inform nurse practitioners in the primary care setting the importance of early screening and referral because of increasing number of liver complications in these patients. This case study highlights the dilemmas a patient with the Fontan procedure faces as a young adult. Methods: Evidence-based articles from the PubMed and Embase databases were used to support the case study. Results: Patients with the low-pressure Fontan circulation are under chronic passive congestion and have known liver complications such as liver fibrosis, cirrhosis, and protein-losing enteropathy. This can lead to a high-risk dual organ heart–liver transplant. Conclusions: Early screening and referral to a hepatologist are critical in these patients. Implications for Nursing: Since patients with congenital heart disease often present to the primary care setting, nurse practitioners in this area should understand the Fontan procedure and its associated complications so they can effectively manage these patients.

Outcome of children referred with heart murmurs referred from general practice to a paediatrician with expertise in cardiology

2014 ◽  
Vol 25 (1) ◽  
pp. 123-127 ◽  
Author(s):  
Abha Khushu ◽  
Anthony W. Kelsall ◽  
Juliet A. Usher-Smith
Keyword(s):  
Primary Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Family History ◽  
General Practitioners ◽  
Congenital Heart ◽  
Hospital Records ◽  
Heart Murmurs ◽  
History Of ◽  
Referral Practice

AbstractBackgroundHeart murmurs are common in children. The majority are detected incidentally, and congenital heart disease is rare. There are no published United Kingdom guidelines for management of children with murmurs in primary care. Common practice is to refer all children for specialist assessment.AimTo review outcomes of children with heart murmurs who were referred by general practitioners to a clinic conducted by a paediatrician with expertise in cardiology.Design and settingA retrospective review of children referred by general practitioners to a paediatrician with expertise in cardiology.MethodsHospital records of all children under 17 years of age who attended the clinic during 2011 were reviewed. We excluded children previously seen by any cardiology service.ResultsThere were 313 new primary care referrals, with complete records available for 310 children. Of them, 186 (60%) were referred with a murmur: 154 for an asymptomatic murmur alone, and 32 for a murmur plus additional symptoms or family history of congenital heart disease. All underwent echocardiography. Of the patients, 38 (20%) had congenital heart disease. Younger children were more likely to have congenital heart disease. There was no difference between rates of congenital heart disease in children with or without symptoms or a family history.ConclusionThe finding that a large proportion of children referred by general practitioners with asymptomatic heart murmurs have congenital heart disease supports current referral practice on clinical grounds.

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