Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-24T16:24:03.141Z Has data issue: false hasContentIssue false
  • English
  • Français

Revision: review of non-elective hospitalisations of adults with CHD

Published online by Cambridge University Press:  10 July 2017

Alexandra Soufi ,
Jack M. Colman ,
Qunyu Li ,
Erwin N. Oechslin  and
Adrienne H. Kovacs
Alexandra Soufi
Affiliation:
Cardio-Pediatric and Congenital Medico-Surgical Department, Cardiologic Hospital Louis Pradel, Lyon, France Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
Jack M. Colman
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
Qunyu Li
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
Erwin N. Oechslin
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
Adrienne H. Kovacs*
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
*
Correspondence to: A. H. Kovacs, PhD, Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, 585 University Avenue, 5N-519, Toronto, ON, Canada, M5G 2N2. Tel: 416 340 4871; Fax: 416 340 5014; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

The adult CHD population is increasing and ageing and remains at high risk for morbidity and mortality. In a retrospective single-centre study, we conducted a comprehensive review of non-elective hospitalisations of adults with CHD and explored factors associated with length of stay.

Methods

We identified adults (⩾18 years) with CHD admitted during a 12-month period and managed by the adult CHD service. Data regarding demographics, cardiac history, hospital admission, resource utilisation, and length of stay were extracted.

Results

There were 103 admissions of 91 patients (age 37±10 years; 52% female). Of 91 patients, 96% had moderate or complex defects. Of 103 admissions, 45% were through the emergency department. The most common reasons for admission were arrhythmia (37%) and heart failure (28%); 29% of admissions included a stay in the ICU. The mean number of consultations by other services was 2.0. Electrophysiology and anaesthesiology departments were most frequently consulted. After removing outliers, the mean length of stay was 7.9±7.4 days (median=5 days). The length of stay was longer for patients admitted for heart failure (12.2±10.3 days; p=0.001) and admitted directly to the ward (9.6±8.9 days; p=0.009).

Conclusions

Among non-electively hospitalised adults with CHD in a tertiary-care centre, management often entails an interdisciplinary approach, and the length of stay is longest for patients admitted with heart failure. The healthcare system must ensure optimal resources to maintain high-quality care for this expanding patient population.

Keywords

Adult CHDhospitalisationheart failurelength of stay
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1764 - 1770
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Moons, P, Bovijn, L, Budts, W, Belmans, A, Gewillig, M. Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium. Circulation 2010; 122: 2264–2272.CrossRefGoogle ScholarPubMed
2. Marelli, AJ, Ionescu-Ittu, R, Mackie, AS, Guo, L, Dendukuri, N, Kaouache, M. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 2014; 130: 749–756.CrossRefGoogle ScholarPubMed
3. Warnes, CA. The adult with congenital heart disease: born to be bad? J Am Coll Cardiol 2005; 46: 1–8.CrossRefGoogle ScholarPubMed
4. Verheugt, CL, Uiterwaal, CS, van der Velde, ET, et al. The emerging burden of hospital admissions of adults with congenital heart disease. Heart 2010; 96: 872–878.CrossRefGoogle ScholarPubMed
5. Oechslin, EN, Harrison, DA, Connelly, MS, Webb, GD, Siu, SC. Mode of death in adults with congenital heart disease. Am J Cardiol 2000; 86: 1111–1116.CrossRefGoogle ScholarPubMed
6. Nieminen, HP, Jokinen, EV, Sairanen, HI. Causes of late deaths after pediatric cardiac surgery: a population-based study. J Am Coll Cardiol 2007; 50: 1263–1271.CrossRefGoogle ScholarPubMed
7. Verheugt, CL, Uiterwaal, CS, van der Velde, ET, et al. Mortality in adult congenital heart disease. Eur Heart J 2010; 31: 1220–1229.CrossRefGoogle ScholarPubMed
8. Mackie, AS, Pilote, L, Ionescu-Ittu, R, Rahme, E, Marelli, AJ. Health care resource utilization in adults with congenital heart disease. Am J Cardiol 2007; 99: 839–843.CrossRefGoogle ScholarPubMed
9. Opotowsky, AR, Siddiqi, OK, Webb, GD. Trends in hospitalizations for adults with congenital heart disease in the U.S. J Am Coll Cardiol 2009; 54: 460–467.CrossRefGoogle ScholarPubMed
10. Cedars, A, Benjamin, L, Vyhmeister, R, et al. Contemporary hospitalization rate among adults with complex congenital heart disease. World J Pediatr Congenit Heart Surg 2016; 7: 334–343.CrossRefGoogle ScholarPubMed
11. Tutarel, O, Kempny, A, Alonso-Gonzalez, R, et al. Congenital heart disease beyond the age of 60: emergence of a new population with high resource utilization, high morbidity, and high mortality. Eur Heart J 2014; 35: 725–732.CrossRefGoogle ScholarPubMed
12. Silversides, CK, Marelli, A, Beauchesne, L, et al. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: executive summary. Can J Cardiol 2010; 26: 143–150.CrossRefGoogle Scholar
13. Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation 2008; 118: e714–e833.Google Scholar
14. Baumgartner, H, Bonhoeffer, P, De Groot, NM, et al. ESC guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31: 2915–2957.Google ScholarPubMed
15. Gatzoulis, MA, Hechter, S, Siu, SC, Webb, GD. Outpatient clinics for adults with congenital heart disease: increasing workload and evolving patterns of referral. Heart 1999; 81: 57–61.CrossRefGoogle ScholarPubMed
16. O’Leary, JM, Siddiqi, OK, de Ferranti, S, Landzberg, MJ, Opotowsky, AR. The changing demographics of congenital heart disease hospitalizations in the United States, 1998 through 2010. JAMA 2013; 309: 984–986.CrossRefGoogle ScholarPubMed
17. Islam, S, Yasui, Y, Kaul, P, Marelli, AJ, Mackie, AS. Congenital heart disease hospitalizations in Canada: a 10-year experience. Can J Cardiol 2016; 32: 197–203.CrossRefGoogle Scholar
18. Kaemmerer, H, Bauer, U, Pensl, U, et al. Management of emergencies in adults with congenital cardiac disease. Am J Cardiol 2008; 101: 521–525.CrossRefGoogle ScholarPubMed
19. Kaemmerer, H, Fratz, S, Bauer, U, et al. Emergency hospital admissions and three-year survival of adults with and without cardiovascular surgery for congenital cardiac disease. J Thorac Cardiovasc Surg 2003; 126: 1048–1052.CrossRefGoogle ScholarPubMed
20. Koh, AS, Yap, BT, Le Tan, J. Emergency admissions in Asians with adult congenital heart disease. Int J Cardiol 2011; 151: 54–57.CrossRefGoogle ScholarPubMed
21. Khairy, P, Van Hare, GF, Balaji, S, et al. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Heart Rhythm 2014; 11: e102–e165.CrossRefGoogle Scholar
22. Warnes, CA. Transposition of the great arteries. Circulation 2006; 114: 2699–2709.CrossRefGoogle ScholarPubMed
23. Sridhar, A, Giamberti, A, Foresti, S, et al. Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre. Cardiol Young 2011; 21: 665–669.CrossRefGoogle ScholarPubMed
24. Aboulhosn, J, Williams, R, Shivkumar, K, et al. Arrhythmia recurrence in adult patients with single ventricle physiology following surgical Fontan conversion. Congenit Heart Dis 2010; 5: 430–434.CrossRefGoogle ScholarPubMed
25. Horer, J, Herrmann, F, Schreiber, C, et al. How well are patients doing up to 30 years after a mustard operation? Thorac Cardiovasc Surg 2007; 55: 359–364.CrossRefGoogle ScholarPubMed
26. Cedars, A, Joseph, S, Ludbrook, P. Heart failure in adults who had the Fontan procedure: natural history, evaluation, and management. Curr Treat Options Cardiovasc Med 2013; 15: 587–601.CrossRefGoogle ScholarPubMed
27. Albert, K, Sherman, B, Backus, B. How length of stay for congestive heart failure patients was reduced through six sigma methodology and physician leadership. Am J Med Qual 2010; 25: 392–397.CrossRefGoogle ScholarPubMed
28. Information CIfH. Hospital Morbidity Database. 2013–2014.Google Scholar
29. Whellan, DJ, Zhao, X, Hernandez, AF, et al. Predictors of hospital length of stay in heart failure: findings from Get With the Guidelines. J Card Fail 2011; 17: 649–656.CrossRefGoogle ScholarPubMed
30. Dusemund, F, Steiner, M, Vuilliomenet, A, et al. Multidisciplinary assessment to personalize length of stay in acute decompensated heart failure (OPTIMA II ADHF). J Clin Med Res 2012; 4: 402–409.Google ScholarPubMed
31. Carrington, MJ, Stewart, S. Bridging the gap in heart failure prevention: rationale and design of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) study. Eur J Heart Fail 2010; 12: 82–88.CrossRefGoogle Scholar
32. Washburn, SC, Hornberger, CA. Nurse educator guidelines for the management of heart failure. J Contin Educ Nurs 2008; 39: 263–267.CrossRefGoogle ScholarPubMed
33. Moons, P, De Geest, S, Budts, W. Comprehensive care for adults with congenital heart disease: expanding roles for nurses. Eur J Cardiovasc Nurs 2002; 1: 23–28.CrossRefGoogle ScholarPubMed
34. Kovacs, AH, Saidi, AS, Kuhl, EA, et al. Depression and anxiety in adult congenital heart disease: predictors and prevalence. Int J Cardiol 2009; 137: 158–164.CrossRefGoogle ScholarPubMed
35. Bromberg, JI, Beasley, PJ, D’Angelo, EJ, Landzberg, M, DeMaso, DR. Depression and anxiety in adults with congenital heart disease: a pilot study. Heart Lung 2003; 32: 105–110.CrossRefGoogle ScholarPubMed
36. Beauchesne, LM, Therrien, J, Alvarez, N, et al. Structure and process measures of quality of care in adult congenital heart disease patients: a pan-Canadian study. Int J Cardiol 2012; 157: 70–74.CrossRefGoogle ScholarPubMed
37. Welke, KF, Karamlou, T, Diggs, BS. Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease – a comparison of administrative and clinical data. Cardiol Young 2008; 18 (Suppl 2): 137–144.CrossRefGoogle ScholarPubMed
38. Zomer, AC, Uiterwaal, CS, van der Velde, ET, et al. Mortality in adult congenital heart disease: are national registries reliable for cause of death? Int J Cardiol 2011; 152: 212–217.CrossRefGoogle ScholarPubMed