Key result
Routine ambulatory care surveillance in adult congenital heart disease was inefficient, with 80% of appointments resulting in no clinical decision and rare new findings on electrocardiograms (5.1%) and echocardiograms (4.0%).
Why the study?
The adult congenital heart disease population is growing in size and complexity, raising questions about whether current ambulatory care adequately detects problems and accounts for costs.
Observational (n=100)
No
Standard ambulatory surveillance in adult congenital heart disease is costly and inefficient at predicting or preventing emergency hospital admissions, highlighting the need to reconsider current models of care.
May warrant reevaluating routine surveillance in adult congenital heart disease; leaves open whether risk-stratified or virtual models improve outcomes.
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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Coats et al. (2022) conducted an observational in Adult Congenital Heart Disease (ACHD) (n=100). Routine ambulatory care surveillance was evaluated on Proportion of clinic appointments resulting in clinical decisions or new investigation findings. Routine ambulatory care surveillance in adult congenital heart disease was inefficient, with 80% of appointments resulting in no clinical decision and rare new findings on electrocardiograms (5.1%) and echocardiograms (4.0%).
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