Children’s Hospitals May Be Best for Adult Congenital Heart Patients

Despite being treated at a hospital designed for pediatric care, adult patients with congenital heart disease fare as well as kids at Nationwide Children’s. These are the findings from a study appearing in the International Journal of Cardiology that provides more data to the discussion as to where adult patients with childhood heart complications belong.

Adults with congenital heart disease comprise one of the fastest growing populations within cardiology; 90 percent of all infants born with a congenital heart defect are expected to survive into adulthood. Yet for many reasons, most of the patients are lost to care after adolescence and present to cardiology care during a health crisis, requiring cardiac procedures and hospitalization. Should adult congenital heart disease patients be admitted to an adult hospital where there is typically little or no experience with congenital heart disease anatomy, physiology, diagnostic tests and invasive procedures? Or should they go to a pediatric hospital where there is expertise in congenital heart disease and the performance and interpretation of diagnostic and invasive studies, but have facilities geared to children with typically no adult services and anxiety among staff caring for adult patients?

Faculty at Nationwide Children’s studied the outcomes of 782 adult patients (ranging from 18 to 80 years of age) who received cardiac surgery or another condition-related procedure at Nationwide Children’s between 2002 and 2007. These patient outcomes were then compared with measures for children receiving cardiac care at the same institution since there currently aren’t alternative benchmarks or standardized quality measures to compare with adult congenital heart outcomes.

Results showed that there were no significant differences in outcomes between the age groups. Throughout the examined period, only 4 of the 782 patients were transferred to an adult institution, one who elected to be transferred for dialysis.  Nationwide Children’s experienced a lower mortality and complication rate than other institutions. This study is the first to show that a free-standing pediatric hospital with an onsite multidisciplinary adult congenital heart disease service can achieve high survival rates and quality of life with an adult patient population.

Our program demonstrates a unique model for care of the adult congenital heart disease patient,” said Curt Daniels, MD, director of the Adolescent and Adult Congenital Heart Disease Program and one of the study authors.  “A multidisciplinary discussion of each case assures a balanced consideration of risks and benefits and promotes patient-focused decision making.

These findings suggest that future models of adult congenital heart disease care that incorporate multidisciplinary programs within a pediatric hospital should be considered to care for this growing, unique and complex population.
 

Crumb SR, et al. Quality outcomes of ACHD patients undergoing cardiovascular procedures and hospital admissions in a free-standing children's hospital. Int J Cardiol. 2009 Aug 7. [Epub ahead of print]