Determinants of outpatient clinic attendance amongst adults with congenital heart disease and outcome

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Title: Determinants of outpatient clinic attendance amongst adults with congenital heart disease and outcome
Author(s): Kempny, A
Diller, G-P
Dimopoulos, K
Alonso-Gonzalez, R
Uebing, A
Li, W
Babu-Narayan, S
Swan, L
Wort, SJ
Gatzoulis, MA
Item Type: Journal Article
Abstract: Background: Adult congenital heart disease (ACHD) guidelines advise life-long, regular, follow up in predefined intervals for ACHD patients. However, limited data exist to support this position. We examine, herewith, compliance to scheduled outpatient clinic appointments and its impact on outcome. Methods and results: We examined 4461 ACHD patients (median age at entry 26.4 years, 51% female) and their follow up records at our tertiary centre between 1991 and 2008. Clinic attendance was quantified from electronic hospital records. For survival analysis we employed the last clinic attendance before 2008 as starting of follow-up. Overall 23% of scheduled clinic appointments were not attended. The main predictors of clinic non-attendance (CNA) were younger age, non-Caucasian ethnicity, lower socioeconomic status, number of previous CNAs and the lack of planned additional investigation/s (e.g. echocardiography) scheduled on the same day. During a cumulative follow-up time of 48,828 patient-years, 366 (8.2%) patients died. Both, the number of CNAs (HR = 1.08, 95% CI 1.05–1.12 per CNA, P < 0.001) and the ratio of CNA to follow up period (HR = 1.23, 95% CI 1.04–1.44 per CNA/year, P = 0.013) emerged as predictors of mortality independent of adjustment for patients' age, disease complexity, functional class and socioeconomic status. Conclusions: Patient adherence to scheduled ACHD outpatient-clinics is associated with better survival. Identifying patients at an increased risk of CNA in a single tertiary centre is feasible. Our data provides previously lacking evidence supporting the practice of periodic assessment of ACHD patients at tertiary clinics. Non-attenders should be specifically targeted and receive counselling to modulate their increased risk of death.
Publication Date: 22-Oct-2015
Date of Acceptance: 12-Oct-2015
URI: http://hdl.handle.net/10044/1/43461
DOI: https://dx.doi.org/10.1016/j.ijcard.2015.10.081
ISSN: 1874-1754
Publisher: Elsevier
Start Page: 245
End Page: 250
Journal / Book Title: International Journal of Cardiology
Volume: 203
Sponsor/Funder: British Heart Foundation
Funder's Grant Number: FS/11/38/28864
Copyright Statement: © 2015 Published by Elsevier Ireland Ltd. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Congenital heart disease
Adult congenital heart disease
Outcome
PULMONARY VALVE-REPLACEMENT
CARDIOVASCULAR MAGNETIC-RESONANCE
FOLLOW-UP
REPAIRED TETRALOGY
CARDIAC-DISEASE
GREAT-ARTERIES
TASK-FORCE
FALLOT
EXERCISE
PREVALENCE
Adult congenital heart disease
Congenital heart disease
Outcome
Adult
Ambulatory Care Facilities
England
Female
Heart Defects, Congenital
Humans
Male
Outcome Assessment (Health Care)
Patient Compliance
Predictive Value of Tests
Retrospective Studies
Social Class
Survival Analysis
Cardiovascular System & Hematology
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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