Association of Adults With Congenital Heart Disease-Specific Care With Clinical Characteristics and Healthcare Use.
J Am Heart Assoc
; 10(11): e019598, 2021 06.
Article
in En
| MEDLINE
| ID: mdl-34041921
ABSTRACT
Background Many adults with congenital heart disease (ACHD) are cared for by non-ACHD specialists, if they receive care at all. Little is known about the differences between those who access care at an ACHD center and those who do not access ACHD-specific care. Methods and Results The Oregon All Payer All Claims database was queried to identify subjects aged 18 to 65 years with an International Classification of Diseases,Ninth Revision (ICD-9) code consistent with ACHD from 2010 to 2015. ACHD center providers were identified using National Provider Identification numbers. Usage rates and percentages were calculated with person-years in the denominator, and rate ratios and odds ratios (ORs) were estimated using negative binomial and logistic regression. Only 11.7% of identified individuals (N=10 199) were seen at the ACHD center. These individuals were younger (median 36 versus 47 years; P<0.0001) and had higher rates of Medicaid insurance (47.8% versus 28.4%; P<0.0001), heart failure (31.4% versus 15.3%; P<0.0001), and arrhythmia (75.5 versus 49.2%; P<0.0001). They had more visits of all types (outpatient 79% per year versus 64% per year [age-adjusted OR, 2.54; 99% CI, 2.24-2.88]; emergency department 29% versus 22% per year [adjusted OR, 1.34; 99% CI, 1.18-1.52]; inpatient 17% versus 12.0% per year [adjusted OR, 1.92; 99% CI, 1.67-2.20]). Rates of guideline-indicated annual echocardiography were low (7.7% overall, 13.4% in patients at the ACHD center). Conclusions Patients at an ACHD center comprise a distinct and complex group with a high rate of healthcare use and a relatively higher compliance with guideline-indicated annual follow-up. These findings underscore the importance of building and supporting robust systems for ACHD care in the United States.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Patient Acceptance of Health Care
/
Delivery of Health Care
/
Heart Defects, Congenital
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
J Am Heart Assoc
Year:
2021
Type:
Article