Key result
Prenatal screening detects ~58% of infant surgical CHD, lagging in rural and vulnerable populations.
Why the study?
To determine the prenatal detection rate of congenital heart disease in Arizona and describe factors that may influence detection rates.
Observational (n=1,137)
Yes
Prenatal detection of congenital heart disease is improving overall, but significant disparities remain for rural, publicly insured, and Native American populations.
Disparities in prenatal CHD detection persist despite gains; leaves open targeted strategies to achieve equity.
OBJECTIVE: To determine the prenatal detection rate (PDR) of congenital heart disease (CHD) in Arizona as well as describe various factors that may influence detection rates. METHODS: This was a retrospective chart review using the Society of Thoracic Surgeons and Phoenix Children's Fetal Cardiology databases. We included all cases of CHD requiring surgery <1 year of age between 2013 and 2018. A total of 1137 patients met the criteria, and various demographic, socioeconomic, and patient outcome data were collected. RESULTS: The overall PDR was 58% with an improving detection rate over the course of our study, with the final year having a PDR of 67%. Over time, PDR improved in urban communities, but this was not seen in rural communities. Rural address, public insurance, and Native American ethnicity were associated with lower PDR. Postnatal outcomes, including Apgars, initial pH, and lactate, did not differ with the presence of a prenatal diagnosis. Diagnoses typically identified with the outflow tract and 3-vessel views on the fetal echocardiogram were less likely to be detected prenatally. CONCLUSIONS: The PDR of CHD continues to improve with evolving technologies and guidelines. We highlight a discrepancy between urban, rural, and Native American populations. Additionally, by supplying descriptors of missed diagnosis and associated echocardiography views, we hope to provide data for future interventions.
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Mattia et al. (2023) conducted an observational in Congenital heart disease (n=1,137). Prenatal screening was evaluated on Prenatal detection rate (PDR) of congenital heart disease. The overall prenatal detection rate of congenital heart disease requiring surgery <1 year of age was 58%, with lower rates in rural, publicly insured, and Native American populations.
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