ABSTRACT. Objectives. More than 85% of children born today with chronic medical conditions will live to adulthood, and many should transfer from pediatric to adult health care. The numbers of adults with congenital heart defects (CHDs) are increasing rapidly. Current guidelines recommend that just over half of adult CHD patients should be seen every 12 to 24 months by a cardiologist with specific CHD expertise at a regional CHD center, because they are at risk for serious complications (eg, reoperation and/or arrhythmias) and premature mortality. The present study aimed to determine the percent of young adults with CHDs who successfully transferred from pediatric to adult care and examine correlates of successful transfer.Design. Cross-sectional study with prevalence data from an entire cohort.Setting and Patients. All patients (n ‫؍‬ 360) aged 19 to 21 years with complex CHDs who, according to current practice guidelines, should be seen annually at a specialized adult CHD center were identified from the database of the cardiology program at the Hospital for Sick Children in Toronto, Canada, a pediatric tertiary care center. Of these patients, 234 completed measures about health beliefs, health behaviors, and medical care since age 18 years.Main Outcome Measure. All 15 specialized adult CHD centers in Canada formed the Canadian Adult Congenital Heart (CACH) Network. Attendance for at least 1 follow-up appointment at a CACH center before the age of 22 years was ascertained for all eligible patients. Attendance at a CACH center provides a clear criterion for successful transfer.Results. In the total cohort, 47% (95% confidence interval [CI]: 42-52) had transferred successfully to adult care. There was no difference in rates of successful transfer between patients consenting to complete questionnaires (48%) and those who declined (47%). More than one quarter (27%) of the patients reported having had no cardiac appointments since 18 years.In Conclusions. This is the first study to document the percent of young adults with a chronic illness who successfully transfer to adult care in a timely manner. Patients were from an entire birth cohort from the largest pediatric cardiac center in Canada, and outcome data were obtained on all eligible patients. Similar data should be obtained for other chronic illnesses. There is need for considerable improvement in the numbers of young adults with CHDs who successfully transfer to adult care. At-risk adolescents with CHDs should begin the transition process before their teens, should be educated in the importance of antibiotic prophylaxis, should be contacted if a follow-up appointment is missed, and should be directed to a specific CHD cardiologist or program, with the planned timing being stated explicitly.Adult care needs to be discussed in the pediatric setting, and patients must acquire appropriate beliefs about adult care well before transfer. Developmentally appropriate, staged discussions involving the patient, with and without parents, throughout adolescence may help pa...

Abstract-Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients.In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (nϭ55) or control (nϭ55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1Ϯ15.6 mmHg (SD; PϽ0.0001), and the mean between-group difference was 7.1Ϯ2.3 mmHg (SE; PϽ0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of Ͻ130/80 mmHg compared with 31% of control subjects (PϽ0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1Ϯ3.76; exit, 5.2Ϯ4.30; Pϭ0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. 3 Such results spurred development of chronic care models that engage patients in their own care. 4 Home BP monitoring promotes self-care, improves BP control, and is endorsed by several prominent organizations as an adjunct to hypertension treatment. 5 A recent meta-analysis suggested that adding telemonitoring to self-measurement of BP is even more effective in reducing BP. 6 In the telemonitoring studies, however, a physician or member of the healthcare team reviewed the transmitted data and contacted the patients to adjust antihypertensive treatment.7-13 Thus, it is unclear whether the better outcome was related to the use of a telemonitoring system or the increased involvement of healthcare providers in the treatment process.Previously we reported the development of a home BP telemonitoring system that provided self-care messages on the smartphone of patients immediately after each reading. A.G.L. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. None of the other authors has real or perceived conflicts of interest related to the study.This trial has been registered at www.clinicaltrials.gov (identifier NCT00717665 eliminate the need for a health provider to re...

The encouraging results of this study provide a strong rationale for a long-term, randomized, clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension.