Disparities in Loss to Follow-Up Among Adults With Congenital Heart Disease in North Carolina.
| Autor: | Serfas JD; 609772Duke University Medical Center, Durham, NC, USA., Spates T; 609772Duke University Medical Center, Durham, NC, USA., D'Ottavio A; 169142Duke Clinical Research Institute, Durham, NC, USA., Spears T; 169142Duke Clinical Research Institute, Durham, NC, USA., Ciociola E; 169142Duke Clinical Research Institute, Durham, NC, USA., Chiswell K; 169142Duke Clinical Research Institute, Durham, NC, USA., Davidson-Ray L; 169142Duke Clinical Research Institute, Durham, NC, USA., Ryan G; 169142Duke Clinical Research Institute, Durham, NC, USA., Forestieri N; State Center for Health Statistics, 6800North Carolina Department of Health and Human Services, Raleigh, NC, USA., Krasuski RA; 609772Duke University Medical Center, Durham, NC, USA., Kemper AR; 2650Nationwide Children's Hospital, Columbus, OH, USA., Hoffman TM; 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Walsh MJ; Wake Forest School of Medicine, Winston Salem, NC, USA., Sang CJ; 12278East Carolina University, Greenville, NC, USA., Welke KF; 158310Levine Children's Hospital/Atrium Health, Charlotte, NC, USA., Li JS; 609772Duke University Medical Center, Durham, NC, USA.; 169142Duke Clinical Research Institute, Durham, NC, USA. |
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| Jazyk: | angličtina |
| Zdroj: | World journal for pediatric & congenital heart surgery [World J Pediatr Congenit Heart Surg] 2022 Nov; Vol. 13 (6), pp. 707-715. |
| DOI: | 10.1177/21501351221111998 |
| Abstrakt: | Background: The AHA/ACC Adult Congenital Heart Disease guidelines recommend that most adults with congenital heart disease (CHD) follow-up with CHD cardiologists every 1 to 2 years because longer gaps in care are associated with adverse outcomes. This study aimed to determine the proportion of patients in North Carolina who did not have recommended follow-up and to explore predictors of loss to follow-up. Methods: Patients ages ≥18 years with a healthcare encounter from 2008 to 2013 in a statewide North Carolina database with an ICD-9 code for CHD were assessed. The proportion with cardiology follow-up within 24 months following index encounter was assessed with Kaplan-Meier estimates. Cox regression was utilized to identify demographic factors associated with differences in follow-up. Results: 2822 patients were identified. Median age was 35 years; 55% were female. 70% were white, 22% black, and 3% Hispanic; 36% had severe CHD. The proportion with 2-year cardiology follow-up was 61%. Those with severe CHD were more likely to have timely follow-up than those with less severe CHD (72% vs 55%, P < .01). Black patients had a lower likelihood of follow-up than white patients (56% vs 64%, P = .01). Multivariable Cox regression identified younger age, non-severe CHD, and non-white race as risk factors for a lower likelihood of follow-up by 2 years. Conclusion: 39% of adults with CHD in North Carolina are not meeting AHA/ACC recommendations for follow-up. Younger and minority patients and those with non-severe CHD were particularly vulnerable to inadequate follow-up; targeted efforts to retain these patients in care may be helpful. |
| Databáze: | MEDLINE |
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