TY - JOUR
T1 - Impact of facilities accredited by both adult and pediatric cardiology societies on the outcome of patients with adult congenital heart disease
AU - Mizuno, Atsushi
AU - Niwa, Koichiro
AU - Ochiai, Ryota
AU - Shiraishi, Isao
AU - Sumita, Yoko
AU - Daida, Hiroyuki
AU - Fukuda, Terunobu
AU - Miyamoto, Yoshihiro
AU - Nishimura, Kunihiro
AU - Ogawa, Hisao
AU - Yasuda, Satoshi
N1 - Funding Information:
This research is supported by the “Practical Research Project for Lifestyle-related Diseases including Cardiovascular Diseases and Diabetes Mellitus” from the Japan Agency for Medical Research and Development, AMED (Primary investigator, Satoshi Yasuda).
Publisher Copyright:
© 2019
PY - 2020/1
Y1 - 2020/1
N2 - Background: The emerging burden and need of hospital admission due to adult congenital heart disease (ACHD) will need many facilities with expertise in ACHD. Regional specialized ACHD centers are carrying this increasing patient burden. Although these centers are considered to perform better management than other institutes, their impact on outcome has not been fully evaluated. Methods: We used the Japanese Registry of All cardiac and vascular Diseases (JROAD) and the JROAD Diagnosis Procedure Combination (DPC)/Per Diem Payment System dataset and certification data. We only analyzed adult (≥15 years old) patients with ACHD, defined by the International Classification of Diseases, Tenth Revision, diagnosis codes, between April 1, 2013, and March 31, 2014. We defined a “minimal essential regional ACHD (MER-ACHD) center” as an education institute accredited by adult and pediatric cardiology societies. The primary outcome is 30-day mortality. We investigated the impact of MER-ACHD centers on 30-day mortality by using generalized estimating equations. Results: Of the 538 hospitals registered at JROAD that agreed to participate in the DPC discharge database study, 65 (12.1%) were MER-ACHD centers. Of 4818 patients (46.8% male; age, 50.1 ± 21.4 years), 45.5% were admitted to a MER-ACHD center. Nearly half (48.1%) of the admissions were cases of atrial septal defect, followed by ventricular septal defect, tetralogy of Fallot, and congenital insufficiency of the aortic valve or bicuspid aortic valve. Multivariate analysis revealed a negative impact of emergency admission [1.051 (1.042–1.061)] and a positive impact of MER-ACHD centers [0.986 (0.973–0.999)] on 30-day mortality after adjustment of disease severity. Conclusion: We noted the impact of MER-ACHD centers on 30-day mortality. Further investigation is needed to establish appropriate regional ACHD center criteria to deliver appropriate ACHD management.
AB - Background: The emerging burden and need of hospital admission due to adult congenital heart disease (ACHD) will need many facilities with expertise in ACHD. Regional specialized ACHD centers are carrying this increasing patient burden. Although these centers are considered to perform better management than other institutes, their impact on outcome has not been fully evaluated. Methods: We used the Japanese Registry of All cardiac and vascular Diseases (JROAD) and the JROAD Diagnosis Procedure Combination (DPC)/Per Diem Payment System dataset and certification data. We only analyzed adult (≥15 years old) patients with ACHD, defined by the International Classification of Diseases, Tenth Revision, diagnosis codes, between April 1, 2013, and March 31, 2014. We defined a “minimal essential regional ACHD (MER-ACHD) center” as an education institute accredited by adult and pediatric cardiology societies. The primary outcome is 30-day mortality. We investigated the impact of MER-ACHD centers on 30-day mortality by using generalized estimating equations. Results: Of the 538 hospitals registered at JROAD that agreed to participate in the DPC discharge database study, 65 (12.1%) were MER-ACHD centers. Of 4818 patients (46.8% male; age, 50.1 ± 21.4 years), 45.5% were admitted to a MER-ACHD center. Nearly half (48.1%) of the admissions were cases of atrial septal defect, followed by ventricular septal defect, tetralogy of Fallot, and congenital insufficiency of the aortic valve or bicuspid aortic valve. Multivariate analysis revealed a negative impact of emergency admission [1.051 (1.042–1.061)] and a positive impact of MER-ACHD centers [0.986 (0.973–0.999)] on 30-day mortality after adjustment of disease severity. Conclusion: We noted the impact of MER-ACHD centers on 30-day mortality. Further investigation is needed to establish appropriate regional ACHD center criteria to deliver appropriate ACHD management.
KW - Adult patients with congenital heart disease
KW - Congenital
KW - Minimal essential
KW - Mortality
KW - Regional adult patients with congenital heart disease center
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U2 - 10.1016/j.jjcc.2019.06.010
DO - 10.1016/j.jjcc.2019.06.010
M3 - Article
C2 - 31421934
AN - SCOPUS:85070553088
SN - 0914-5087
VL - 75
SP - 105
EP - 109
JO - Journal of Cardiology
JF - Journal of Cardiology
IS - 1
ER -