Chances of Employment in a Population of Women and Men after Surgery of Congenital Heart Disease: Gender-Specific Comparisons between Patients and the General Population

Introduction: The most common comorbidities in children with congenital heart disease (CHD) are neurodevelopmental and psychosocial impairments, particularly in areas of executive function, memory, attention, and behavioral control. Limited studies in the adult CHD population suggest similar impairments exist and adults with CHD may be at increased risk for dementia. No studies have screened specifically for mild cognitive impairment and dementia in adult CHD patients. Methods: We performed a prospective cross-sectional study of adult CHD patients, ages 30-65 years, who were coming for routine clinic visits. We administered the Mini-Mental State Exam (MMSE) and scores were compared with population norms adjusted by age and education level. We also evaluated the association of MMSE scores with CHD complexity, demographic and clinical risk factors. Results: A total of 125 patients were recruited (55% male). The median age was 40 years (range 30-65). Almost all participants (97%) had a high school degree and 75% had some college education or advanced degrees. The majority of patients (94%) had moderate or complex CHD. Adjusting for age and education, CHD participants scored significantly lower than the general population (median 1 point lower, p=0.001). The greatest impairments occurred in recall and orientation. Factors associated with lower scores included decreased systemic ventricular function (p=0.028) and having ≥2 cardiac catheterizations (p=0.006). Five percent of the total cohort met the general threshold for mild cognitive impairment (MMSE<24). Clinical factors associated with this degree of cognitive impairment were duration of cyanosis (p=0.005) and decreased systemic ventricular function (p=0.003). Conclusions: Our pilot study showed that, when adjusted for age and education level, adult CHD patients had significantly lower MMSE scores than the general population, with 5% meeting criteria for mild cognitive impairment. These findings suggest that subtle and early neurodevelopmental changes are present in the adult CHD population. Further studies are needed to investigate those changes and evaluate potential disease modifying therapies that might influence long-term outcomes in the adult CHD population.

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Contraception and pregnancy

10.1093/med/9780199228188.003.0028 ◽

2011 ◽

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

High Risk ◽

General Population ◽

Congenital Heart ◽

Post Partum ◽

Maternal Risk ◽

Risk Of Death ◽

Pregnancy And Delivery

Introduction 208General principles 208Contraception 210Preconception 214Pregnancy and delivery 218Post-partum 220Heart disease is the largest single cause of maternal death in the UK4. The number and complexity of survivors of congenital heart disease well enough to consider pregnancy is growing. The maternal risk amongst this population varies from being no different to that of the general population, to carrying a high risk of long-term morbidity and >40% risk of death....

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Life chances after surgery of congenital heart disease: the influence of cardiac surgery on intergenerational social mobility. A comparison between patients and general population data

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/01.hjr.0000238398.27471.39 ◽

2007 ◽

Vol 14 (1) ◽

pp. 128-134 ◽

Cited By ~ 13

Author(s):

Siegfried Geyer ◽

Kambiz Norozi ◽

Monika Zoege ◽

Reiner Buchhorn ◽

Armin Wessel

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

General Population ◽

Social Mobility ◽

Congenital Heart ◽

Population Data ◽

Life Chances

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CANCER IN ADULTS WITH CONGENITAL HEART DISEASE COMPARED TO THE GENERAL POPULATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)60795-5 ◽

2012 ◽

Vol 59 (13) ◽

pp. E794

Author(s):

Michelle Gurvitz ◽

Louise Pilote ◽

Patrick Lawler ◽

Mark Eisenberg ◽

Raluca lonescu-Ittu ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

General Population ◽

Congenital Heart

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Congenital Heart Disease in the General Population

Circulation ◽

10.1161/circulationaha.106.627224 ◽

2007 ◽

Vol 115 (2) ◽

pp. 163-172 ◽

Cited By ~ 1011

Author(s):

Ariane J. Marelli ◽

Andrew S. Mackie ◽

Raluca Ionescu-Ittu ◽

Elham Rahme ◽

Louise Pilote

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

General Population ◽

Congenital Heart

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Abstract 18971: Heart Transplantation for Adult Patients With Congenital Heart Disease: Are the Outcomes Still Worse Than in the General Population in 2015?

Circulation ◽

10.1161/circ.132.suppl_3.18971 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Diego Moguillansky ◽

Biagio A Pietra ◽

Frederick J Fricker ◽

Mark S Bleiweis

Keyword(s):

Congenital Heart Disease ◽

Survival Analysis ◽

Heart Disease ◽

General Population ◽

Heart Transplantation ◽

Heart Transplant ◽

Congenital Heart ◽

Medium Term ◽

General Group

Introduction: Short and medium term outcome after heart transplantation has steadily improved over the last few decades. Outcomes for adult patients with congenital heart disease (ACHD) who undergo transplantation are generally considered to be less favorable. Hypothesis: We hypothesized that the development of heart teams that specialize in ACHD would lead to improved outcomes after transplantation in this population. Methods: We reviewed the records of all patients undergoing first heart transplant at a university center with a dedicated ACHD team over the last 10 years. Patients undergoing re-transplantation were excluded. We looked at short (30 days) and medium term (1 year) survival after heart transplantation in ACHD patients. Results: Between 1/1/05 and 6/10/15, 258 patients underwent heart transplantation. Of the 258 patients, 17 were re-transplants and were excluded. Of the remaining 241 patients, 12 were ACHD patients and 229 were transplanted for other diagnosis (general group). In the general group 184 of 212 (86.8%) patients were alive at 1 year (the remaining 17 did not have sufficient follow up to be included in the 1-year survival analysis). In the ACHD group 9 of 9 patients (100%) were alive at 1 year. The remaining 3 ACHD patients with insufficient follow up to be included in the 1-year survival analysis were still alive 2.5-9.5 months after transplant, such that all 12 ACHD patients survived at least 30 days and were discharged home after heart transplant. At the end of the study period 160 of 229 (70%) patients were still alive in the general group, compared to 8 of 12 (66.7%) in the ACHD group. Conclusions: Short and medium term survival after heart transplantation appears to be no worse for selected ACHD patients compared to the general population. Larger studies with longer follow up are needed to confirm our findings and clarify the intermediate and long-term outcomes of ACHD patients undergoing heart transplantation in the modern era.

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Abstract 149: Utilization and Costs of Hospitalization among Adolescents and Young Adults with Congenital Heart Disease in California

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a149 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Yang Lu ◽

Garima Agrawal ◽

Roberta G Williams

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

General Population ◽

Young Adulthood ◽

Congenital Heart ◽

Age Groups ◽

Early Years ◽

Charge Ratio ◽

Care Utilization ◽

Hospitalization Costs

Background: Congenital heart disease (CHD) often requires intensive surgeries and care, especially in the early years of a CHD patient. However, it is not well understood how their health care utilization and costs vary as CHD patients transition into young adulthood. Objective: We aim to identify the utilization patterns of hospitalization by age among CHD patients 10-29 years old and to measure the associated costs as compared with the general population in California. Methods: We utilized the California State Inpatient Database (SID) and the Healthcare Cost and Utilization Project (HCUP) Cost-to-Charge Ratio Files 2005-2009. By merging the two datasets, we obtained data on about 97% of all hospital discharge records in California including principal and secondary diagnoses, principal and secondary procedures, admission and discharge status, basic patient demographics, total charges, imputed total costs, and length of stay (LOS). Hospital discharges of CHD patients were identified by one or more principal or secondary ICD-9 diagnosis codes of 745.xx, 746.xx, or 747.xx. Utilization and cost patterns were compared to the general population by 5-year age groups (10-14, 15-19, 20-24, and 25-29). We then conducted a multivariate linear regression with the CHD population to understand how age and other factors influence costs of hospitalization per stay. Results: The average hospitalization costs per stay among CHD patients remain 2-3 times as high as that of the general population across all age groups ($21-31k vs. $7k-12k). However, the total hospitalization costs of the CHD population monotonically decrease as patients with CHD age into adulthood: in 2005-2009, the total costs were $75m in the 10-14 group, $74m in the 15-19 group, $50m in the 20-24 group and $48m in the 25-29 group, which represented 3.8%, 1.7%, 0.8%, 0.7% of the total costs in the general population of the respective age group. The decline in total costs by age among the CHD population manifested in both decreasing numbers of hospitalizations and lower costs per stay. Other observed trends include increasing fraction of admissions from the emergency department (ED), decreasing fraction of surgery-related hospitalizations, and shorter LOS as CHD population age into adulthood. Regression results within the CHD population 10-29 years old (n=9680) suggest that costs per stay were positively associated with LOS (+$2674, p<.001) and were negatively associated with being 25-29 years old (-$3240, p<.001), being female (-$1935, p<.001), having no surgeries (-$16758, p<.001) or other procedures performed ($21396, p<.001), and being admitted from the ED (-$3638, p<.001). Conclusion: The CHD population incurs lower hospitalization costs as they age into young adulthood.

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