scholarly journals Association of Insurance Status With Emergent Versus Nonemergent Hospital Encounters Among Adults With Congenital Heart Disease

2021 ◽  
Vol 10 (19) ◽  
Author(s):  
Anushree Agarwal ◽  
Michelle Gurvitz ◽  
Janet Myers ◽  
Sarthak Jain ◽  
Abigail M. Khan ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Health Planning ◽  
Private Insurance ◽  
Insurance Status ◽  
The Past ◽  
Use Of Resources ◽  
Hospital Visits ◽  
The Relationship

Background Although the number of hospital visits has exponentially increased for adults with congenital heart disease (CHD) over the past few decades, the relationship between insurance status and hospital encounter type remains unknown. The purpose of this study was to evaluate the association between insurance status and emergent versus nonemergent encounters among adults with CHD ≥18 years old. Methods and Results We used California Office of Statewide Health Planning and Development Database from January 2005 to December 2015 to determine the trends of insurance status and encounters and the association of insurance status on encounter type among adults with CHD. A total 58 359 nonpregnancy encounters were identified in 6077 patients with CHD. From 2005 to 2015, the number of uninsured encounters decreased by 38%, whereas government insured encounters increased by 124% and private by 79%. Overall, there was a significantly higher proportion of emergent than nonemergent encounters associated with uninsured status (13.0% versus 1.8%; P <0.0001), whereas the proportion of nonemergent encounters associated with private insurance was higher than emergent encounters (35.8% versus 62.4%; P <0.0001). When individual patients with CHD became uninsured, they were ≈5 times more likely to experience an emergent encounter ( P <0.0001); upon changing from uninsured to insured, they were significantly less likely to have an emergent encounter ( P <0.001). After multivariate adjustment, uninsured status exhibited the highest odds of an emergent rather than nonemergent encounter compared with all other covariates (adjusted odds ratio, 9.20; 95% CI, 7.83–10.8; P <0.0001). Conclusions Efforts to enhance the ability to obtain and maintain insurance throughout the lifetime of patients with CHD might result in meaningful reductions in emergent encounters and a more efficient use of resources.

Abstract 16601: Impact of Insurance Status on Emergent Versus Non-Emergent Hospital Encounters Among Adults With Congenital Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anushree Agarwal ◽  
Michelle Z GURVITZ ◽  
Janet Myers ◽  
Sarthak Jain ◽  
Abigail Khan ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Health Planning ◽  
Insurance Coverage ◽  
Insurance Status ◽  
Use Of Resources ◽  
Before And After ◽  
Insured Patients ◽  
The Impact

Background: Arguments against universal health insurance are ongoing, but insurance coverage may be beneficial in high-risk populations such as adults with congenital heart disease (ACHD). While the number of hospital visits have exponentially increased for ACHD over the last few decades, the impact of insurance on the type of hospital encounters remains unknown. Hypothesis: Uninsured ACHD patients are more likely to have emergent hospital encounters than those insured. Methods: Using California Office of Statewide Health Planning and Development Database from 01/2005 to 10/2015, we identified all hospital encounters that were emergent (which might or might not have resulted in an admission) or nonemergent among ACHD ≥18 years old. We determined the trends over time and odds of insurance status on emergent vs. nonemergent encounters. Results: Among 69,876,425 encounters, 72,142 were in patients with CHD diagnoses (mean age 49±12 years, 43% males, 52% Caucasian, 4% uninsured). 78% had severe CHD and 75% had a comorbidity. From 2005 to 2015, while all ACHD encounters increased by 108% (p for trend <0.0001), there was significantly higher increase in emergent than nonemergent encounters (331% vs. 87%; p<0.0001). The ratio of emergent:nonemergent encounters was significantly higher for uninsured than insured patients (3.18 vs. 1.02; p<0.0001). Non-cardiac diagnoses were more common among emergent than non-emergent encounters (68% vs. 36%; p<0.0001). Both before and after multivariable adjustment, uninsured status was associated with a significantly higher odds of emergent encounters for all ACHD (Figure), irrespective of CHD type, exhibiting the largest magnitude of effect compared to any other predictor. Conclusions: Efforts to enhance the ability to obtain and maintain insurance throughout the lifetime of ACHD patients might result in meaningful reductions in emergency encounters and a more efficient use of resources.

Changing Profile of Congenital Heart Disease

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 790-791
Author(s):  
D. WOODROW BENSON ◽  
James Moller ◽  
Donald C. Fyler ◽  
David E. Fixler
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Surgical Treatment ◽  
Congenital Heart ◽  
Considerable Change ◽  
Diagnostic Methods ◽  
Younger Patients ◽  
The Past ◽  
Steady Improvement ◽  
Complex Lesions

In the past 20 years, considerable change has occurred in the profile of congenital heart disease regarding both diagnosis and treatment. The profile has changed from older to younger patients; the essence of this change has been from pediatric to infant to neonatal cardiology. There has been a shift from palliative to more definitive surgical procedures and a change from invasive (cardiac catheterization) to noninvasive (echocardiography) diagnostic methods. The profile has changed from definitive surgical treatment limited to simple lesions to surgical treatment of the most complex lesions. There has been steady improvement in the recognition of cases of congenital heart disease. Of all children admitted to hospitals for treatment of congenital heart disease, the portion less than three days of age has increased from 24% in 1969 to 1972 to 33% in 1982 to 1986.

Diet and Growth in Congenital Heart Disease

PEDIATRICS ◽  
1976 ◽  
Vol 57 (1) ◽  
pp. 75-86
Author(s):  
Alice Strangway ◽  
Rodney Fowler ◽  
Kathrine Cunningham ◽  
J. Richard Hamilton
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Nutrient Intake ◽  
Congenital Heart ◽  
Growth Failure ◽  
Entire Group ◽  
Dietary Study ◽  
Cardiac Status ◽  
Rates Of Growth ◽  
The Relationship

To assess the relationship between diet and growth in congenital heart disease we studied nutrient intake, body measurements, and cardiac status in 568 affected ambulatory patients less than 11 years of age. Most had mild heart disease, 104 were cyanotic, and only 10 were in congestive heart failure. Major disturbances of growth were uncommon. For the entire group body weight was below normal but only in those studied before 2 years of age; rates of growth and weight gain were normal over the period preceding the dietary study. There was no statistically significant relationship between intake of calories, protein, or other nutrients and growth or gain, analyzing the entire group, or analyzing patients subgrouped according to age, severity of heart disease, or severity of growth retardation. Body size and growth were diminished in cyanosed compared with noncyanosed children but cardiac status had no effect on nutrient intake. We conclude that in children with growth failure associated with congenital heart disease, nutrient intake is not an important factor limiting their growth.

scholarly journals The relationship between hopelessness and perceived social support levels of parents with children with congenital heart disease

2021 ◽  
Vol 8 (11) ◽  
pp. 655-661
Author(s):  
Tugba Nur Oden ◽  
Rahsan Cam
Keyword(s):  
Social Support ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Perceived Social Support ◽  
Significant Negative Correlation ◽  
Cross Sectional ◽  
The Family ◽  
The Mean ◽  
The Relationship

Objective: This study was conducted to evaluate the relationship between hopelessness and perceived social support levels of parents with children with congenital heart disease (CHD). Material and Methods: This cross-sectional study was conducted with parents of children who underwent surgery for CHD, and data were collected from 100 parents who agreed to participate in the study. A descriptive information form for the sociodemographic characteristics of the parents, “Beck Hopelessness Scale (BHS)” and “Multidimensional Scale of Perceived Social Support (MSPSS)” were used to collect the data. Data were analysed using descriptive statistics and Spearman’s correlation tests. Results: The mean score of the hopelessness level of the parents participating in the study was 6.15±4.23, and the mean perceived general social support score was 69.55±15.47. There was a significant negative correlation between the hopelessness levels of mothers and social support (SS) received from the family, from significant others, and general SS scores. There was a significant positive correlation between the hopelessness levels of the mothers and the SS level received from the family (p<0.05). Conclusion: In this study, the parents of children with CHD have low levels of hopelessness and perceived SS levels are high. Moreover, the relationship between hopelessness and perceived SS levels varies according to the sex of the parents. In our study, the SS level of mothers had a higher effect on the hopelessness level. It is recommended that the SS levels of the parents of children with CHD should be increased to help them cope with hopelessness.

An Atlas of Congenital Heart Disease

PEDIATRICS ◽  
1963 ◽  
Vol 32 (6) ◽  
pp. 1077-1077
Author(s):  
NORMAN J. SISSMAN
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Clinical Management ◽  
Congenital Heart ◽  
Pathological Examination ◽  
Children's Hospital ◽  
The Past ◽  
Present Volume ◽  
Children’S Hospital

Despite the vast experience accumulated during the past decade with all aspects of the lives and deaths of patients with congenital heart disease, there is still room for the clarification and direction that careful, informed, imaginative analysis of the results of pathological examination of postmortem material can give to the clinical management of these patients. Dr. Sherman has made a notable contribution in this area with the present volume. The atlas was compiled from 503 specimens collected in the Museum of Congenital Heart Disease at the Children's Hospital in Pittsburgh since 1954.

scholarly journals The relationship between endothelial progenitor cells and pulmonary arterial hypertension in children with congenital heart disease

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hong-Xiao Sun ◽  
Guo-Ju Li ◽  
Zhan-Hui Du ◽  
Zhen Bing ◽  
Zhi-Xian Ji ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Peripheral Blood ◽  
Congenital Heart ◽  
Pulmonary Arterial ◽  
The Relationship

Abstract Background Pulmonary arterial hypertension (PAH) caused by congenital heart disease (CHD) is very common in clinics. Some studies have shown that PAH is related to the number of endothelial progenitor cells (EPCs), but there is no report on the relationship between PAH and the number of EPCs in children with CHD. Methods In this study, a total of 173 cases with CHD (from 0 to 6 years old) were collected. According to the mean pulmonary arterial pressure (mPAP) measured by right heart catheterization, these cases were divided into PAH groups (including high PAH group, mPAP> 25 mmHg, n = 32, and the middle PAH group, 20 mmHg ≤ mPAP≤25 mmHg, n = 30) and non-PAH group (mPAP< 20 mmHg, n = 111). Peripheral blood was taken for flow cytometry, and the number of EPCs (CD133+/KDR+ cells) was counted. The number of EPCs /μL of peripheral blood was calculated using the following formula: EPCs /μL = WBC /L × lymphocytes % × EPCs % × 10− 6. Results The median EPCs of the non-PAH group, middle PAH group and high PAH group is 1.86/μL, 1.30 /μL and 0.98/μL, respectively. The mPAP decreases steadily as the level of EPCs increases (P < 0.05). After adjustment of gender, age and BMI, the number of EPCs was significantly associated with a decreased risk of high PAH (OR = 0.37, 95% CI: 0.16–0.87, P < 0.05). However, EPCs was not significantly associated with middle PAH (P > 0.05). Conclusion The findings revealed that the EPCs and high PAH in patients with CHD correlate significantly and EPCs may become an effective treatment for PAH in patients with CHD. EPCs may be a protective factor of high PAH for children with CHD.

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