Impact of Adult Congenital Heart Disease Specialists Visits on Emergent Admissions: Evidence for Guidelines.

Overview

abstract

BACKGROUND: Although routine outpatient visits with adult congenital heart defect (ACHD) specialists have been recommended, the evidence to support this remains sparse. OBJECTIVES: The purpose of this study was to evaluate the association between outpatient ACHD visits and emergent admissions. METHODS: This observational study used standardized electronic health record data from 13 health centers from January 1, 2015 through December 31, 2019. Mixed logistic regression analyses examined the effects of number of outpatient ACHD specialist visits (1-2 considered routine) during a 6-month period on an emergent admission in the subsequent 6-month period, after adjusting for cohort characteristics, CHD severity, and center. Analysis was stratified by ACHD anatomic types and medical conditions associated with or without physiological CHD class. RESULTS: The 16,142 patients (median age 32 years, 44.9% women, 83.2% White) contributed to 118,079 person-periods, an average of 7.3 periods per person. Between 1.3% and 2.7% of patients had one emergent admission per 6-month period. Patients with zero, 3, 4, or more than 4 prior outpatient visits had 1.34, 1.67, 2.08-, and 2.48 times higher odds of emergent admission, respectively, than those with a prior routine visit (P < 0.05 using the Wald test). The stratified adjusted analysis demonstrated similar J-shaped (nonlinear) relationships by presence of medical conditions but not by anatomic type. CONCLUSIONS: Having routine outpatient ACHD specialist visits over a 6-month period reduces the likelihood of an emergent admission in the subsequent period, findings driven by presence of medical conditions and not anatomic severity. These findings provide supporting evidence for the ACHD guidelines and implementation science research.