Trends in hospital admissions, in-hospital case fatality and population mortality from congenital heart disease in England, 1994 to 2004

Abstract

Admission rates for CHD have increased over the past decade, particularly amongst patients in older age groups. There has also been a significant decrease in both in-hospital case fatality rates and in general population mortality rates. These trends are consistent with improvements in the quality of care for these patients, improvements in survival and the predicted expansion in the number of adults living with CHD.

Infant deaths in the UK community following successful cardiac surgery: building the evidence base for optimal surveillance, a mixed-methods study

“…59 Outcomes with home monitoring programme All studies reported benefit in terms of outcome; however, comparisons between patient groups were based on historic control patients in an era during which outcomes for children with CHD have improved. 3,60 Although it seems likely that interventions such as HMP have contributed to improved long-term outcomes over the era in which these have been introduced, the lack of randomised studies means that this cannot be confirmed.…”

“…2,3 Although many of the deaths that do occur early are in association with surgery, the outcomes for this immediate phase of in hospital care have improved overall in recent years 4 with current 30-day mortality rates at historically low levels. The scope of audit beyond 30 days after operation is limited; however, UK National Congenital Heart Diseases Audit (NCHDA) data indicate that significant numbers of deaths do occur more than 30 days after neonatal cardiac surgery but within the first postoperative year.…”

“…7 It is also important to note that babies with CHDs who survive past their first birthday are subsequently at a lower mortality risk during childhood. 3,8 Although considerable emphasis has been placed on quantifying and exploring what risk factors impact on early postoperative and in-hospital mortality [9][10][11][12] and on improving treatment strategies for within hospital care, including surgical techniques 13 and postoperative management approaches, 14 resulting in net benefit to patients, less attention has been paid to the risks and care pathways post discharge. An exception to this is the case of hypoplastic left heart syndrome (HLHS), for which teams from the USA have reported the benefits of enhanced surveillance known as home monitoring programmes (HMPs).…”

Improving risk adjustment in the PRAiS (Partial Risk Adjustment in Surgery) model for mortality after paediatric cardiac surgery and improving public understanding of its use in monitoring outcomes

“…Patients often need a complex combination of medicines, hospital visits and treatments, leading to high levels of health-care utilisation. [85][86][87][88][89] CHD services are expensive and high profile and have an enormous impact on patients' lives, but there is currently no cohesive strategy to measure outcomes across settings and providers. Thus, 30-day survival in children after cardiac intervention is no longer an adequate proxy on its own for quality in CHD services.…”

Prevalence of extracardiac malformations associated with congenital heart disease

“…Since a large number of births in our country take place at home, mostly unsupervised by a qualified doctor, hospital statistics are unlikely to be truly representative. 4 Apart from that, statistics of live births may miss out a large number of CHDs, which present later in life. The hospital admission rate from birth to 14 years for CHD between [2003][2004], in the NHS hospitals of England was found to be 1.8 per 1000 hospital admissions.…”