The Increasing Burden Of Adult Congenital Heart Disease On Pediatric Hospitals Across The United States
Kevin Kulshrestha, MD, MBE, John T. Kennedy, III, MD, Jason W. Greenberg, MD, MS, Awais Ashfaq, MD, Nicole M. Brown, MD, David G. Lehenbauer, MD, Alexander R. Opotowsky, MD, David L. S. Morales, MD.
Cincinnati Children's Hospital Medical Center Heart Institute, Cincinnati, OH, USA.
Objective: Adults with congenital heart disease (ACHD) constitute a growing cohort. The authors characterized the clinical volume ACHD represents at pediatric centers.
Methods: All PHIS encounters for patients age>=18 years with ICD-9/10 code indicating congenital heart disease were identified between 1/1/2003-12/31/2022. The cohort was described by specific patients and across encounters.
Results: 57,105 patients were identified across 323,008 encounters at 47 centers. Median number of encounters/patient was 3[IQR=1-6]. Median age was 20[18-29] at first encounter and 24[20-32] at most recent encounter. Divided into five-year eras, encounters/era increased over time (2003-2007:n=12,932, 4%; 2008-2012:n=54,763, 17%; 2013-2017:n=100,258, 31%; 2018-2022:n=155,055, 48%; Figure). Most common diagnoses were ASD/PFO (12,899, 23%), VSD (10,763, 19%), aortic valve pathology (10,480, 18%), aorta pathology (8,677, 15%), tetralogy of Fallot (6,792, 12%), and pulmonary valve pathology (6,597, 12%). Median center volume was 2,528[1,691-7,570] encounters; a plurality occurred in Midwest centers (107,782, 33%). 47,035 encounters involved hospitalization, with median hospital stay of 4[2-7]days and in-hospital mortality in 632 (1.3%) of patients. There were 2,549 septal repairs, 7,940 valvular interventions, 491 coronary interventions, and 263 heart transplants performed. Median encounter charges were $55,413[$23,887-$130,600] for inpatients & $1,769[$403-$4,814] for outpatients, with total billed charges of $8,054,682,813.
Conclusions: With ~50% of all ACHD pediatric hospital encounters over the past 20yrs occurring in the last 5 years, pediatric institutions are experiencing a growing wave of ACHD patients across care settings.
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