Association between insurance type, clinical characteristics, and healthcare use in adults with congenital heart disease.

Introduction: Adults with congenital heart disease (CHD) represent a heterogeneous and growing population with high healthcare utilization. We sought to understand the association between insurance type, healthcare use, and outcomes among adults with CHD in Oregon.

Methods: The Oregon All Payers All Claims database from 2010 to 2017 was queried for adults aged 18-65 in 2014 with ICD-9 or 10 codes consistent with CHD; patient demographics, comorbidities, healthcare use, and disease severity were identified.

Hospital Care for Adult Patients with Congenital Heart Diseases.

Objective: The ideal type of hospital to care for adult congenital heart disease (ACHD) patients is not well known. Hospital competitiveness, clinical volume and market structure can influence clinical outcomes. We sought to understand how hospital competitiveness affects clinical outcomes in ACHD patients in the era prior to the Adult Congenital Heart Association accreditation program.

Factors Associated With Nonattendance at the Adult Congenital Heart Disease Clinic.

Adults with congenital heart disease (CHD) are a complex population for whom adult CHD-specific care results in better outcomes. Our objective was to identify factors associated with no-shows and cancelations in an adult CHD (ACHD) clinic and evaluate the efficacy of a social worker intervention to promote ambulatory follow-up. The medical record identified adults with a scheduled appointment in the adult CHD clinic from January 2017 to March 2021.

Substance Use Disorders Are Prevalent in Adults With Congenital Heart Disease and Are Associated With Increased Healthcare Use.

Adults with congenital heart disease (CHD) represent a heterogeneous group with significant long-term health risks. Previous studies have demonstrated a high prevalence of psychiatric disorders among adults with CHD; however, little is known about the frequency of co-morbid substance use disorders (SUDs) in patients with CHD. The Oregon All Payer All Claims (APAC) database for the years 2014 to 2017 was queried for adults aged 18 to 65 years with International Classification of Diseases, Ninth or Tenth Revision codes consistent with CHD.

Racial Disparity: The Adult Congenital Heart Disease Surgery Perspective.

The influence of race and ethnicity on clinical outcomes in medicine are widely acknowledged. However, the effect of race on adult congenital heart disease (ACHD) surgery is not known. We sought to evaluate the possible association between race and outcomes following ACHD operations.

Prevalence of traditional and non-traditional cardiovascular risk factors in adults with congenital heart disease.

Background: Adults with congenital heart disease (CHD) may be at increased risk of acquired cardiovascular disease (CVD). Understanding the prevalence of CV risk factors (CVRF) in this population is an important step in developing strategies to mitigate long-term risk.

Methods: The Oregon All Payer All Claims database for the years 2010-2017 was queried for adults with CHD International Classification of Diseases (ICD) codes.

Echocardiographic changes and impact on clinical management in pregnant women with heart disease.

Background: While guidelines recommend echocardiography for pregnant women with heart disease, there are limited data on its effect on clinical practice. In this study, we investigated pregnancy-associated echocardiographic changes and their impact on management.

Methods: This was a retrospective study of pregnant women with heart disease followed at an academic medical centre from 2016 to 2020.

Operational and Ethical Considerations for a National Adult Congenital Heart Disease Database.

As more adults survive with congenital heart disease, the need to better understand the long-term complications, and comorbid disease will become increasingly important. Improved care and survival into the early and late adult years for all patients equitably requires accurate, timely, and comprehensive data to support research and quality-based initiatives. National data collection in adult congenital heart disease will require a sound foundation emphasizing core ethical principles that acknowledge patient and clinician perspectives and promote national collaboration.

Utility of continuous electrocardiographic monitoring in pregnant women with cardiovascular disease.

Background: Arrhythmias are a common complication in pregnant women with heart disease. While continuous electrocardiographic monitoring is a useful tool for diagnosis, it also has significant associated costs, and identifying which pregnant women are most likely to benefit from monitoring is an important goal.

Methods: This is a retrospective observational study of pregnant adult women with heart disease cared for at an academic medical center between 2016 and 2020.

Distance to Care, Rural Dwelling Status, and Patterns of Care Utilization in Adult Congenital Heart Disease.

Many patients with adult congenital heart disease (ACHD) do not receive guideline-directed care. While distance to an ACHD center has been identified as a potential barrier to care, the impact of distance on care location is not well understood. The Oregon All Payer All Claims database was queried to identify subjects 18-65 years who had a health encounter from 2010 to 2015 with an International Classification of Diseases-9 code consistent with ACHD.

Association of Insurance Status With Emergent Versus Nonemergent Hospital Encounters Among Adults With Congenital Heart Disease.

Background Although the number of hospital visits has exponentially increased for adults with congenital heart disease (CHD) over the past few decades, the relationship between insurance status and hospital encounter type remains unknown. The purpose of this study was to evaluate the association between insurance status and emergent versus nonemergent encounters among adults with CHD ≥18 years old. Methods and Results We used California Office of Statewide Health Planning and Development Database from January 2005 to December 2015 to determine the trends of insurance status and encounters and the association of insurance status on encounter type among adults with CHD.

Barriers to care in urban and rural dwelling adults with congenital heart disease.

Introduction: Adults with congenital heart disease (CHD) face a unique set of medical, psychological, and social challenges, and access to specialised adult congenital heart disease care has been associated with improved outcomes. Rural adults with CHD may represent a uniquely disadvantaged group given additional challenges when accessing specialised care. The aim of this study was to investigate the challenges faced by adults with CHD in accessing outpatient cardiac care, with a specific focus on understanding differences between urban- and rural-dwelling patients.

Association of Adults With Congenital Heart Disease-Specific Care With Clinical Characteristics and Healthcare Use.

Background Many adults with congenital heart disease (ACHD) are cared for by non-ACHD specialists, if they receive care at all. Little is known about the differences between those who access care at an ACHD center and those who do not access ACHD-specific care. Methods and Results The Oregon All Payer All Claims database was queried to identify subjects aged 18 to 65 years with an () code consistent with ACHD from 2010 to 2015.

Ambulatory Health Care Service Use and Costs Among Commercially Insured US Adults With Congenital Heart Disease.

This study examines the ambulatory health care use and costs of adults with congenital heart disease in the US.

Left ventricular strain and fibrosis in adults with repaired tetralogy of Fallot: A case-control study.

Background: Left ventricular (LV) systolic dysfunction and myocardial fibrosis have prognostic implications in repaired tetralogy of Fallot (rTOF), but their relationship with myocardial strain is not well understood. We evaluated systolic strain and fibrosis (extracellular volume fraction, ECV) of the left ventricle (LV) using feature tracking with magnetic resonance and determine their association with each other and clinical outcome.

Method: Adults with rTOF and age-matched controls underwent CMR to measure LV-ECV.

Too little too late? Communication with patients with congenital heart disease about challenges of adult life.

Objective: To investigate the experiences and communication preferences of adult patients with congenital heart disease (CHD) in the domains of employment, insurance, and family planning.

Design: Patients ≥ 18 years of age completed a questionnaire about experiences and communication preferences regarding employment, health insurance, and family planning.

Results: Of 152 patients (median age = 33 years, 50% female, 35% with CHD of great complexity), one in four reported work-related problems due to CHD and a quarter also recalled a previous gap in health insurance.

Safety profile of ultrasound enhancing agents in echocardiography.

Introduction: Ultrasound enhancing agents (UEAs) are often utilized to enhance ultrasound image quality; however, concerns about adverse reactions have limited their use. Moreover, these agents had been either contraindicated or are labeled with a warning in patients with intra-cardiac shunts because of a theoretic risk of systemic microvascular obstruction. This labeling was recently removed in the United States, but data in these patients are lacking.

Psychological distress in adults with congenital heart disease: focus beyond depression.

Background: Adults with congenital heart disease face psychological challenges although an understanding of depression vs. anxiety symptoms is unclear. We analyzed the prevalence of elevated symptoms of anxiety and depression and explored associations with demographic and medical factors as well as quality of life.

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

Background This study assessed trends in heart failure ( HF) hospitalizations and health resource use in patients with adult congenital heart disease ( ACHD ). Methods and Results The Nationwide Inpatient Sample was used to compare ACHD with non- ACHD HF hospitalization and health resource trends. Health resource use was assessed using total hospital charges, hospital length of stay, and procedural burden.

Peripartum Cardiomyopathy: a Review for the Clinician.

Purpose Of Review: This review summarizes the pathophysiology, diagnosis, and treatment of peripartum cardiomyopathy (PPCM), with a focus on recent discoveries of clinical relevance.

Recent Findings: An increase in oxidative stress and anti-angiogenic activity play key roles in the pathophysiology of peripartum cardiomyopathy. Therapies that target this dysregulation may have a future role in treatment.

Epidemiology of ACHD: What Has Changed and What is Changing?

The worldwide population of adults with congenital heart disease (ACHD) has grown steadily over the last few decades, estimated at approximately 1.4 million people in 2010 (Gilboa et al., 2016).