Abstract 12115: Adult Congenital Heart Disease Centre Care: A Population Based Analysis of Impact on Mortality
Background: The first Canadian Consensus Conference on Adult Congenital Heart Disease (ACHD) was held in l996, with proceeds published in 1998 recommending referral of ACHD care to specialized centers. Over a decade later, no study has documented that specialized ACHD care improves outcomes. We undertook an analysis to determine the impact of ACHD care on mortality.
Methods: Time-series analyses from 1990-2005 were performed using the Quebec ACHD database. ACHD centers were defined as hospital centers where > 500 ACHD patients were seen yearly. The study population consisted of patients aged 18-65 years identified with CHD in the 7 years prior to the year of measurement. Patients were considered referred to an ACHD center if they visited a qualifying ACHD center in the year of measurement. Yearly referral and mortality rates were analyzed using Joinpoint regression to detect the year at which a significant change occurred, and Poisson regression to analyze time trends before and after change-points.
Results: For referral to ACHD centers, a significant change-point with an increase in referral was observed in 1997. For mortality, a significant change-point with a decrease in mortality was observed in 2000. For both trends, a significant interaction was observed between year and a binary indicator of the period before and after the change-point, with p<0.0001 for referral rates and p<0.01 for mortality rates (Figure).
Conclusions: A decrease in mortality was observed concurrent with an increase in referral visits to ACHD centers with a lag of 3 years. These observations coincide with the introduction of national guidelines recommending a shift in care patterns for ACHD patients. To our knowledge, this is the first study to demonstrate a relationship between specialized ACHD care and mortality. Our findings are expected to inform policy for the care of this growing population.
- © 2011 by American Heart Association, Inc.