Specialized Adult Congenital Heart Care Saves Lives
For more than half a century, growing numbers of practitioners and clinician-scientists have created systems for and practiced healthcare delivery within centers of expertise for young and older adults with congenital heart disease (CHD). To date, this has been driven largely by energy, enthusiasm, and shared mission without supportive data demonstrating the benefit of such adult CHD (ACHD) care programs in the lives of patients and families served by this developing field. Now, for the first time, Mylotte and colleagues1 present in this issue of Circulation good evidence that there is a survival advantage to ACHD patients being cared for by ACHD specialists. This confirms what those working in this field had long assumed and hoped but to date could not substantiate.
Article see p 1804
The authors used their own extensively validated, province-wide, administrative longitudinal database that has been highly effective in demonstrating the demography and epidemiology of ACHD care in Québec, Canada, as a model for North America. Their study included data from 1990 to 2005. They performed an elegant combination of time-series analysis together with case-control studies that included year-dependent survival and center-dependent survival so as to determine mortality trends within a highly monitored and geographically stable group of adults with CHD. A number of important findings emerged. Specialized ACHD care was independently associated with reduced mortality. Among patients who died, just under half died of cardiovascular diseases. Other causes of death included neoplasms (≈18%), respiratory disease (≈9%), and diseases of other systems …