LOSS TO FOLLOW-UP IN PATIENTS WITH CONGENITAL HEART DEFECTS: FAILED TRANSITION FROM PEDIATRIC TO ADULT CARE OR A RETENTION ISSUE IN ADOLESCENCE? Público

Deshmukh, Anura (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/mc87pq96s?locale=es
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Abstract

Purpose: To determine 1) how many Georgia adolescents with a Congenital Heart Defect (CHD) received continuous care from 2008-2010; 2) how many of them successfully transitioned into adult congenital care; and 3) a predictive model of risk factors for loss to follow-up and successful transition.

Method: Data from an ongoing pilot CHD surveillance project were used to identify a cohort of adolescent patients, 16-21 years old seen at Sibley Heart Center, Pediatric Cardiology Services (PCS), or Children's Healthcare of Atlanta (CHOA) during 2008 or 2009. Evidence of transitioning into adult care was searched for in Emory Healthcare, St. Joseph's Hospital, Grady Health, or Georgia Medicaid data during 2008-2010. Odds ratios were calculated using multivariable logistic regression.

Results: After controlling for age, sex, insurance, proximity, CHD severity, number of procedures, and comorbidities,more than half (53.6%) of the adolescents were lost to follow-up and only about 20% successfully transitioned into adult congenital care. Being older and female predicted loss to follow-up, while severity, procedure history and having a comorbidity were protective. Being older, and having public insurance, a severe CHD, a non-CHD birth defect, and a respiratory/pulmonary comorbidity predicted successful transitioning.

Conclusion: As adolescent patients age, follow-up care and proper transitioning into an adult congenital heart defect practice must be reinforced. Implementing a national CHD surveillance program and continuing research on the factors affecting loss to follow-up and successful transitioning can help increase specialized healthcare utilization for those living with a CHD.

Table of Contents

Table of Contents

Distribution Agreement i Approval Sheet ii Abstract Cover Page iii Abstract iv Cover Page v Acknowledgments vi Table of Contents vii List of Abbreviations viii CHAPTER 1 1 Congenital Heart Defects 1

Follow-up Care 3

Transition 5 Loss to Follow-up 7

Risk Factors / Predictors for Loss to Follow-up 8

Protective Factors for Loss to Follow-up / Returning to Care 9

CHAPTER II 11

Introduction 11 Hypotheses 13 Methods 13 Results 18 Discussion 22 Strengths and Limitations 24 References 25 Tables 34 Figures 39 CHAPTER III 41 Appendices 45 Appendix A 45 Appendix B 48 Appendix C 53 Appendix D 55

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