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Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

Background: The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. Methods: A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, med...

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Autores principales: Coats, Louise, Chaudhry, Bill
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9000074/
https://www.ncbi.nlm.nih.gov/pubmed/35407666
http://dx.doi.org/10.3390/jcm11072058
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author Coats, Louise
Chaudhry, Bill
author_facet Coats, Louise
Chaudhry, Bill
author_sort Coats, Louise
collection PubMed
description Background: The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. Methods: A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, median ACHD AP class 2B) between 2014 and 2019 and the COVID-19 restrictions period (March 2020–July 2021). Results: Between 2014 and 2019, there were 575 appointments. Nonattendance was 10%; 15 patients recurrently nonattended. Eighty percent of appointments resulted in no decision other than continued review. Electrocardiograms and echocardiograms were frequent, but new findings were rare (5.1%, 4.0%). Decision-making was more common with the higher ACHD AP class and symptoms. Emergency admissions (n = 40) exceeded elective (n = 25), with over half following unremarkable clinic appointments. Distance travelled to the ACHD clinic was 14.9 km (1.6–265), resulting in 433–564 workdays lost. During COVID 19, there were 127 appointments (56% in-person, 41% telephone and 5% video). Decisions were made at 37% in-person and 19% virtual consultations. Nonattendance was 3.9%; there were eight emergency admissions. Conclusion: The main purpose of the ACHD clinic is surveillance. Presently, the clinic does not sufficiently predict or prevent emergency hospital admissions and is costly to patient and provider. COVID-19 has enforced different methods for delivering care that require further evaluation.
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spelling pubmed-90000742022-04-12 Ambulatory Care in Adult Congenital Heart Disease—Time for Change? Coats, Louise Chaudhry, Bill J Clin Med Article Background: The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. Methods: A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, median ACHD AP class 2B) between 2014 and 2019 and the COVID-19 restrictions period (March 2020–July 2021). Results: Between 2014 and 2019, there were 575 appointments. Nonattendance was 10%; 15 patients recurrently nonattended. Eighty percent of appointments resulted in no decision other than continued review. Electrocardiograms and echocardiograms were frequent, but new findings were rare (5.1%, 4.0%). Decision-making was more common with the higher ACHD AP class and symptoms. Emergency admissions (n = 40) exceeded elective (n = 25), with over half following unremarkable clinic appointments. Distance travelled to the ACHD clinic was 14.9 km (1.6–265), resulting in 433–564 workdays lost. During COVID 19, there were 127 appointments (56% in-person, 41% telephone and 5% video). Decisions were made at 37% in-person and 19% virtual consultations. Nonattendance was 3.9%; there were eight emergency admissions. Conclusion: The main purpose of the ACHD clinic is surveillance. Presently, the clinic does not sufficiently predict or prevent emergency hospital admissions and is costly to patient and provider. COVID-19 has enforced different methods for delivering care that require further evaluation. MDPI 2022-04-06 /pmc/articles/PMC9000074/ /pubmed/35407666 http://dx.doi.org/10.3390/jcm11072058 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Coats, Louise
Chaudhry, Bill
Ambulatory Care in Adult Congenital Heart Disease—Time for Change?
title Ambulatory Care in Adult Congenital Heart Disease—Time for Change?
title_full Ambulatory Care in Adult Congenital Heart Disease—Time for Change?
title_fullStr Ambulatory Care in Adult Congenital Heart Disease—Time for Change?
title_full_unstemmed Ambulatory Care in Adult Congenital Heart Disease—Time for Change?
title_short Ambulatory Care in Adult Congenital Heart Disease—Time for Change?
title_sort ambulatory care in adult congenital heart disease—time for change?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9000074/
https://www.ncbi.nlm.nih.gov/pubmed/35407666
http://dx.doi.org/10.3390/jcm11072058
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