Gatzoulis M A, Hechter S, Siu S C, Webb G D
Toronto Congenital Cardiac Centre for Adults, The Toronto Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
Heart. 1999 Jan;81(1):57-61. doi: 10.1136/hrt.81.1.57.
To examine the evolving role of specialised outpatient services for adult patients with congenital heart disease.
A retrospective analysis of all patients attending the Toronto Congenital Cardiac Centre for Adults over three corresponding three month periods in 1987, 1992, and 1997.
A tertiary referral centre.
Patient demographics, residence, medical and surgical history, type and source of referral, and investigations performed.
In all, 570 patients were seen at the clinic during these three periods. There was a 44% and a 269% increase in workload between 1987 to 1992 and 1992 to 1997, respectively. There was a steady fall in mean age of patients seen at the clinic with time (38.5, 33.6, and 31.7 years in 1987, 1992, and 1997, respectively, p < 0.001). New referrals from community cardiologists and family physicians increased more in relative terms than did referrals from the Hospital for Sick Children, Toronto (6.7%, 15%, and 37.5%, p = 0.02). There was a steady increase in patients with previous reparative surgery (48.9%, 59.2%, and 69.2%, p < 0.002). The proportion of patients with previous reoperations also increased (2.3%, 10%, and 9.2%, p < 0.01). Echocardiography remained the predominant method of diagnosis. The diagnostic mix did not change with time.
Over the past 10 years there has been a large increase in adults with congenital heart disease requiring and seeking specialised care in a tertiary health centre, with a concomitant evolution of referral patterns. These data may be helpful in planning of similar paediatric and adult cardiac services for this expanding population.
探讨成人先天性心脏病专科门诊服务不断演变的作用。
对1987年、1992年和1997年相应的三个月期间在多伦多成人先天性心脏病中心就诊的所有患者进行回顾性分析。
一家三级转诊中心。
患者人口统计学资料、居住地、病史和手术史、转诊类型和来源以及所做的检查。
在这三个时期，该诊所共诊治了570例患者。1987年至1992年以及1992年至1997年期间，工作量分别增加了44%和269%。随着时间的推移，诊所就诊患者的平均年龄稳步下降（1987年、1992年和1997年分别为38.5岁、33.6岁和31.7岁，p<0.001）。社区心脏病专家和家庭医生的新转诊患者相对增加幅度大于多伦多病童医院的转诊患者（分别为6.7%、15%和37.5%，p=0.02）。既往接受过修复手术的患者稳步增加（48.9%、59.2%和69.2%，p<0.002）。既往接受再次手术的患者比例也有所增加（2.3%、10%和9.2%，p<0.01）。超声心动图仍然是主要的诊断方法。诊断组合未随时间变化。
在过去10年中，需要并寻求在三级医疗中心接受专科护理的成人先天性心脏病患者大幅增加，转诊模式也随之演变。这些数据可能有助于为这一不断扩大的人群规划类似的儿科和成人心脏服务。
