Rising adult admissions for congenital heart disease
March 7, 2013
Boston, MA - The annual number of hospitalizations for congenital heart disease among US adults increased more rapidly than hospitalizations among children over a recent 12-year period, new research shows . Between 1998 and 2010, the frequency of hospitalizations among adults admitted for congenital defects has grown twice as fast as that for children, according to the new report.
As a result, annual adult admissions are approaching those of children, with adults now accounting for 36.5% of all congenital heart defect admissions. “The observed trend is likely due to a number of independent forces, including better congenital heart disease survival, an aging population, and accumulating comorbidities,” according to Dr Jared O’Leary (Brigham and Women’s Hospital, Boston, MA) and colleagues in their report, published online March 7, 2013 in the Journal of the American Medical Association. “Limited availability of quality outpatient services may also contribute.”
Using ICD-9 codes from the Nationwide Inpatient Sample, which includes approximately eight million admissions from 1000 US hospitals, the group found that admissions were 87% higher in the period 2004-2010 compared with 1998-2004. In 1998-2004, 331 162 adults were hospitalized for congenital heart disease, whereas 622 084 were hospitalized in 2004-2010. Comparatively, 815 471 children were hospitalized in the first half of the study compared with 1 082 540 admissions in 2004-2010, an increase of 32.4%.
For adults, admissions for simple cardiac defects increased 112.8%, unclassified defects increased 52.6%, and complex congenital defects increased 52.8% from 1998-2004 to 2004-2010. In children, the changes in the rates of hospitalizations for these same defects were 46.3%, -9.8%, and 32.4%, respectively.
“These data do not reflect the number of congenital heart disease patients, but rather the burden of congenital heart disease admissions,” write O’Leary et al. “Because the described factors are not likely to abate, this trend may continue. Adult congenital heart disease admissions will have an increasing impact on resource utilization.”
heartwire first addressed the issue of young men and women born with congenital heart disease, who, only a generation or two ago, rarely made it to their 20s, in a feature article in 2011. Cardiology organizations have also begun to recognize the issue, with the European Society of Cardiology issuing new guidelines for the management of grown-up congenital heart disease in 2010 and the American Heart Association publishing a scientific statement on the topic in 2011. And just last year, the American Board of Medical Specialties (ABMS) said a new subspecialty of adult congenital heart disease will be introduced and available to internal and pediatric medicine cardiology trainees in the US by 2015.
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