TY - JOUR
T1 - Characteristics of hospital admissions associated with implantable cardioverter defibrillator placement among adults with congenital heart disease
AU - Baskar, Shankar
AU - Veldtman, Gruschen R.
AU - Khoury, Philip R.
AU - Opotowsky, Alexander R.
AU - Cedars, Ari M.
N1 - Publisher Copyright:
© 2018 Elsevier B.V.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/10/15
Y1 - 2018/10/15
N2 - Background: Characteristics of hospitalizations including healthcare utilization for adult patients with congenital heart disease (ACHD) at the time of implantable cardioverter defibrillator (ICD) placement has not been well studied. Methods: We analyzed data from the 2002–2014 United States National Inpatient Sample (NIS). ICD implantation, CHD, complications, and indications for admissions were determined based on diagnostic codes among adults. Propensity score matching was performed, based on age, sex and in-hospital mortality index with a 10:1 ratio between adults without CHD and those with CHD, to determine relative healthcare utilization attributable to CHD. Results: ACHD accounted for 136,509 ± 3488 admissions of which 1451 ± 121 admissions (1.1 ± 0.06%) were associated with an ICD placement. ICD placement occurred most frequently among patients with TOF, VSD, and transposition complexes usually in the context of a dysrhythmia. Compared to those without CHD, ACHD patients had higher adjusted total hospital charges ($147,002 ± 5516 vs $132,455 ± 2182; p < 0.001), length of stay (6.2 ± 0.5 vs 5.2 ± 0.1 days; p < 0.001), lower readmission score (5.5 ± 0.5 vs 9.7 ± 0.1; p = 0.04) and a higher complication rate (13.4% vs 8.3%; p < 0.001). Dysrhythmias were more frequently the primary diagnosis for admission in the ACHD cohort (63% vs 38%; p < 0.001). Conclusion: Compared to a matched non-CHD population, ACHD patients had greater healthcare utilization and had more frequent complications. The reasons underlying this difference bear investigation to improve care quality.
AB - Background: Characteristics of hospitalizations including healthcare utilization for adult patients with congenital heart disease (ACHD) at the time of implantable cardioverter defibrillator (ICD) placement has not been well studied. Methods: We analyzed data from the 2002–2014 United States National Inpatient Sample (NIS). ICD implantation, CHD, complications, and indications for admissions were determined based on diagnostic codes among adults. Propensity score matching was performed, based on age, sex and in-hospital mortality index with a 10:1 ratio between adults without CHD and those with CHD, to determine relative healthcare utilization attributable to CHD. Results: ACHD accounted for 136,509 ± 3488 admissions of which 1451 ± 121 admissions (1.1 ± 0.06%) were associated with an ICD placement. ICD placement occurred most frequently among patients with TOF, VSD, and transposition complexes usually in the context of a dysrhythmia. Compared to those without CHD, ACHD patients had higher adjusted total hospital charges ($147,002 ± 5516 vs $132,455 ± 2182; p < 0.001), length of stay (6.2 ± 0.5 vs 5.2 ± 0.1 days; p < 0.001), lower readmission score (5.5 ± 0.5 vs 9.7 ± 0.1; p = 0.04) and a higher complication rate (13.4% vs 8.3%; p < 0.001). Dysrhythmias were more frequently the primary diagnosis for admission in the ACHD cohort (63% vs 38%; p < 0.001). Conclusion: Compared to a matched non-CHD population, ACHD patients had greater healthcare utilization and had more frequent complications. The reasons underlying this difference bear investigation to improve care quality.
KW - Adult congenital heart disease
KW - Complications
KW - Healthcare utilization
KW - Hospital admissions
KW - Implantable cardioverter defibrillator
KW - Outcome data analysis
KW - Propensity score matching
UR - http://www.scopus.com/inward/record.url?scp=85050506959&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050506959&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2018.07.085
DO - 10.1016/j.ijcard.2018.07.085
M3 - Article
C2 - 30060972
AN - SCOPUS:85050506959
SN - 0167-5273
VL - 269
SP - 97
EP - 103
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -