Understanding gaps in guideline-recommended adult congenital heart disease care: Data from 12 US health care centers
Authors' conclusion
Three-quarters of adults with CHD experienced gaps in specialized ACHD care while receiving services at high volume comprehensive tertiary health centers. To address these gaps, interventions such as fostering physician collaboration within tertiary centers might be needed, and targeted to patients with less severe CHD, nonphysiologic class conditions, and those aged 40+ years.
Study context
- Population
- Adults with congenital heart disease (CHD) receiving care at US health care centersCounted separately by period
- Participants
- 18,934 vs 22,453
- Exposure
- Pre-COVID vs COVID
- Pre-COVIDn = 18,934
- COVIDn = 22,453
- Outcome
- 1) Gaps in any adult congenital heart disease (ACHD) specialist visit and recommended testing throughout the study period. 2) Gaps in recommended ACHD follow-up care.
Methodological details12 centers in the national Patient-Centered Clinical Research Network, Pre-COVID (2015-2019) and COVID (2020-2022) periods analyzed separately
- 12 centers in the national Patient-Centered Clinical Research Network
- Pre-COVID (2015-2019) and COVID (2020-2022) periods analyzed separately
Main finding
As reported in the abstract
Gaps in specialist visit (range across periods)
47.0%-54.5%
Gaps in all the testing (range across periods)
13.0%-24.6%
Patients with gaps in follow-up care, in both periods
64.1%-71.5%
Observational data: associations, not effects.
Further findings
Gaps in testing among patients with gaps in specialist visits
- Times more likely to have gaps in testing
- 6.33-9.44
Factors associated with gaps
- Moderate CHD, AOR
- 2.61
- Simple CHD, AOR
- 2.84
- Aged 40+, AOR
- 1.53
- Nonphysiologic class conditions, AOR
- 1.51
- Adjusted odds ratio
Patient characteristics (range across periods)
- Males
- 55.3%-55.8%
- 40+ years
- 27.2%-31.0%
- Severe CHD
- 18.2%-19.6%
- CHD physiologic class B-D conditions
- 52.7%-55.0%
Original publication
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