Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease–Related Heart Failure

Burchill, Luke J.; Gao, Lina; Kovacs, Adrienne H.; Opotowsky, Alexander R.; Maxwell, Bryan G.; Minnier, Jessica; Khan, Abigail; Broberg, Craig S.

doi:10.1161/jaha.118.008775

Cited by 71 publications

(42 citation statements)

References 28 publications

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“…Prolonged hospital length of stay in heart failure patients is a major driver of cost in many health care systems. 16 While baseline B-type natriuretic peptide was not associated with a prolonged hospital length of stay in our Fontan cohort, low haemoglobin and elevated blood urea nitrogen levels were the two laboratory studies that were found to correlate with this outcome. These laboratory values are likely proxies of co-morbidities leading to their association with prolonged hospitalisation due to a higher degree of illness severity.…”

Section: Discussionmentioning

confidence: 59%

Utility of biomarkers in adult Fontan patients with decompensated heart failure

Nguyen¹,

Song

Dolgner

et al. 2020

Cardiol Young

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AbstractBackground:The incidence of heart failure is increasing within the Fontan population. The use of serological markers, including B-type natriuretic peptide, has been limited in this patient population.Methods:This was a single-centre retrospective study of Fontan patients in acute decompensated heart failure. Fontan patients underwent a 1:2 match with non-Fontan patients for each heart failure hospitalisation for comparative analysis. A univariate logistic regression model was used to assess associations between laboratory and echocardiographic markers and a prolonged length of stay of 7 days or greater.Results:B-type natriuretic peptide levels were significantly lower in Fontan patients admitted for heart failure than that in non-Fontan patients [390.9 (±378.7) pg/ml versus 1245.6 (±1160.7) pg/ml, respectively, p < 0.0001] and were higher in Fontan patients with systemic ventricular systolic or diastolic dysfunction than that in Fontan patients with normal systemic ventricular function [833.6 (±1547.2) pg/ml versus 138.6 (±134.0) pg/ml, p = 0.017]. The change from the last known outpatient value was smaller in Fontan patients in comparison with non-Fontan patients [65.7 (±185.7) pg/ml versus 1638.0 (±1444.7) pg/ml, respectively, p < 0.0001]. Low haemoglobin and high blood urea nitrogen levels were associated with a prolonged length of stay.Conclusion:B-type natriuretic peptide levels do not accurately reflect decompensated heart failure in Fontan patients when compared to non-Fontan heart failure patients and should, therefore, be used with caution in this patient population.

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Section: Discussionmentioning

confidence: 59%

Utility of biomarkers in adult Fontan patients with decompensated heart failure

Nguyen¹,

Song

Dolgner

et al. 2020

Cardiol Young

View full text Add to dashboard Cite

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“…It is critical that we provide not just care, but high‐quality care to this burgeoning, high‐risk population. Right now, there is significant room for improvement—from 1998 to 2011, for example, ACHD admissions for heart failure increased by 91% compared to a 21% increase for non‐ACHD heart failure admissions . Further work is needed to determine how to optimize care of this challenging population.…”

Section: Discussionmentioning

confidence: 99%

A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease

Salciccioli

Oluyomi

Lupo

et al. 2019

Congenital Heart Disease

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Background Follow‐up at a regional adult congenital heart disease (ACHD) center is recommended for all ACHD patients at least once per the 2018 ACC/AHA guidelines. Other specialties have demonstrated poorer follow‐up and outcomes correlating with increased distance from health care providers, but driving time to regional ACHD centers has not been examined in the US population. Objective To identify and characterize potential disparities in access to ACHD care in the US based on drive time to ACHD centers and compounding sociodemographic factors. Methods Mid‐ to high‐volume ACHD centers with ≥500 outpatient ACHD visits and ≥20 ACHD surgeries annually were included based on self‐reported, public data. Geographic Information System mapping was used to delineate drive times to ACHD centers. Sociodemographic data from the 2012‐2016 American Community Survey (US Census) and the Environmental Systems Research Institute were analyzed based on drive time to nearest ACHD center. Previously established CHD prevalence estimates were used to estimate the similarly located US ACHD population. Results Nearly half of the continental US population (45.1%) lives >1 hour drive to an ACHD center. Overall, 39.7% live 1‐4 hours away, 3.4% live 4‐6 hours away, and 2.0% live >6 hours away. Hispanics were disproportionately likely to live a >6 hour drive to a center (p < .001). Compared to people with <1 hour drive, those living >6 hours away have higher proportions of uninsured adults (29% vs. 18%; p < .001), households below the federal poverty level (19% vs. 13%; p < .001), and adults with less than college education (18% vs. 12%; p < .001). Conclusions We estimate that ~45% of the continental US population lives >1 hour to an ACHD center, with 5.4% living >4 hours away. Compounding barriers exist for Hispanic, uninsured, lower socioeconomic status, and less‐educated patients. These results may help drive future policy changes to improve access to ACHD care.

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“…The paradigm of non-operative management of previous generations had, in some ways, stymied broad acceptance and given cause to thwart intervention where there was no perceived benefit. However, percutaneous management of ASD in elderly patients has gained reluctant enthusiasm, as evidenced by analyzing trends in hospitalizations captured by the National Inpatient Sample Database [103][104][105][106] . The promise of shorter hospitalization time and reduced complication rates is tempered with the many difficulties faced perioperatively due to the tendency toward combined comorbidities.…”

Section: Special Issues In the Management Of Elderly Patients With Asdmentioning

confidence: 99%

Atrial septal defect repair in the age of transcatheter devices

Zimmermann¹,

Hussain²,

Worku³

et al. 2019

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The aim of this review is to discuss the management of atrial septal defects (ASD) in the adult patient paying special attention to the elderly population and the most recent transcatheter advancements. ASDs are characterized by the following categories: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects; though multiple defects may exist concurrently. Intervention for closure of ASDs are indicated with the development of right ventricular volume overload, or in the clinical context of paradoxical embolic stroke. Previously, there was significant disagreement regarding the timing of ASD closure in adult patients, but there is now general consensus that adult patients with clinical evidence of right ventricular overload should undergo closure of ASDs at the time of presentation. The present review describes the typical presentation of patients with symptomatic ASD's, medical management, and whether surgical or percutaneous approach should be pursued. We will also discuss other important considerations for patient selection and potential early and late complications of transcatheter ASD closure such as congestive heart failure, device embolization, and tissue erosion. At the time of this writing, there are currently three FDA-approved devices for percutaneous VSD closure including the Amplatzer TM Septal Occluder (ASO, St. Jude Medical, St. Paul, MN), Gore HELEX TM Septal Occluder (W.L. Gore and Associates, Newark, NJ), and Gore CARDIOFORM TM Septal occluder (GCSO, W.L. Gore and Associates, Newark, NJ) devices. Many premarket approvals were granted for devices that never went to market due to poor investigational study performance. Likewise, the HELEX device has since been discontinued upon bringing the GCSO device to market. We will focus primarily on the ASO device with a brief review of current investigations into the GCSO device, both of which carry an indication for closure small to medium sized ASDs in the ostium secundum position. Additionally, this review covers the safety of transcatheter closure of ASDs with currently available devices, review studies associated with devices available outside the United States, and perioperative considerations for transcatheter Page 2 of 18 Zimmermann et al. Vessel Plus 2019;3:31 I http://dx.intervention. Obstacles to device employment and countermeasures to overcome operational challenges will also be discussed. To this end, variations or similarities of currently approved devices will be emphasized throughout this discussion where possible. Lastly, we will offer insights into device evolution trends with the expectation of new device developments on the horizon. We will briefly discuss up and coming areas of active research, including the emerging fields of novel biomaterials and gene therapy. MORPHOLOGY AND CLINICAL FEATURES OF ASDS Location, Morphology, and suitability for surgery vs. transcatheter interventionIt is important to note that morphological variations of different types of ASDs, which determines whether a particular defect is amenabl...

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Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease–Related Heart Failure

Cited by 71 publications

References 28 publications

Utility of biomarkers in adult Fontan patients with decompensated heart failure

Utility of biomarkers in adult Fontan patients with decompensated heart failure

A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease

Atrial septal defect repair in the age of transcatheter devices

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