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17262

Cardiac Resource Utilization In Adults At a Freestanding Children's Hospital

Friday, October 19, 2012
Room 275-277 (Morial Convention Center)
Peter R. Ermis, MD, Wayne Franklin, Jeffrey J. Kim, Douglas Moodie and Dhaval Parekh, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX

Purpose: Admission of adults to freestanding pediatric institutions is increasing in many centers due to the population of chronic childhood disease survivors. Few studies have looked at inpatient and procedural-related resource use by this population, and none include a complete evaluation of all cardiac resource utilization, especially outpatient-related care. We hypothesize that our institution (a large tertiary freestanding pediatric hospital) will have seen a marked increase in the use of cardiac services by adults during the last several years due to this growing population. 

Methods: Data was collected retrospectively on all adults seen within the heart center or evaluated by heart center personnel at our institution from January 1, 2006 through December 31, 2010.

Results: A total of 2,796 unique patients were included in the study group. There were 245 admissions that involved the cardiology service and 194 patients evaluated in the emergency room. A total of 117 cardiac operations and 461 cardiac catheterizations were performed. Table 1 summarizes the specific encounter data.

Table 1 – Event Summary - 2006-2010.

Event Type

2006

2007

2008

2009

2010

Total

Surgery

20

18

11

28

48

117

Diagnostic Catheterizations

29

45

34

45

55

208

Interventional Catheterizations

16

11

11

8

22

68

Electrophysiology Studies and Ablations

32

7

14

14

22

89

Devices

17

21

16

21

21

96

Admissions

19

6

62

76

82

245

Emergency Room Evaluations

48

31

31

56

28

194

Clinic Visits

867

799

828

1073

1922

5489

Electrocardiograms

432

411

391

510

807

2551

Transthoracic Echocardiograms

512

599

663

820

1261

3855

Transesophageal Echocardiograms

0

12

18

25

47

102

Ambulatory Electrocardiograms

278

221

196

340

297

1332

Exercise Stress

99

66

79

129

184

557

Pacemaker Evaluations

98

99

148

279

363

987

Cardiac MRI

43

46

69

94

108

360

A total of 72% of the patients had a diagnosis of congenital heart disease (CHD). The most common cardiac diagnoses in this population were isolated atrial septal defect (6.2%) and ventricular septal defect (6.2%). Of the patients with CHD, 60% had disease of moderate or severe complexity. There were no deaths in the non-surgical procedures, and the overall minor and major complication rates were 4.8% and 0.7%, respectively. For the surgical admissions, the in-hospital mortality was 0%. 

Conclusion:  The adult population of patients with chronic childhood diseases represents a marked resource burden for the health care system. The optimal location for care of this population presents a challenge to the current care structure and often leads to individual facilities having to adapt their resources accordingly, often in a way that leads to suboptimal care. As seen in this study, this large and growing population of patients displays a high incidence of cardiac resource utilization.