Collins R Thomas, Fram Ricki Y, Tang Xinyu, Robbins James M, St John Sutton Martin
Departments of Pediatrics; Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
J Cardiovasc Electrophysiol. 2014 Feb;25(2):179-86. doi: 10.1111/jce.12294. Epub 2013 Oct 21.
The study sought to identify the impact of cardiac arrhythmias on hospitalizations in adults with single ventricle (SV) congenital heart disease (CHD).
Surgical advances have dramatically improved survival in patients with CHD. Cardiac arrhythmias and sudden cardiac death are common in adults with CHD.
Data from 43 pediatric hospitals in the 2004 to 2011 Pediatric Health Information System database were used to identify patients ≥18 years of age admitted with International Classification of Diseases-9th Revision codes for a diagnosis of either hypoplastic left heart syndrome (HLHS), tricuspid atresia (TA) or common ventricle (CV), and a cardiac arrhythmia. Primary and secondary diagnoses, length of stay (LOS), hospital charges, and interventional procedures were determined. Multilevel models were used to evaluate differences in demographics, diagnoses, and clinical outcomes among the 3 subgroups (HLHS, TA, and CV). Interactions of charges with arrhythmia and admission year were examined using ANOVA. There were 642 admissions in 424 patients with SV CHD and an arrhythmia diagnosis. A single arrhythmia diagnosis was present in 454 admissions (71%). Total hospital charges were $80.7 million with mean charge per admission of $127,296 ± 243,094. The mean charge per hospital day was $16,653 ± 17,516 and increased across the study period (P < 0.01). Arrhythmia distributions were impacted by SV anatomic subtype (P < 0.001). Hospital resource utilization was significantly different among arrhythmia groups (P < 0.001).
In adults with SV CHD, arrhythmias are affected by SV anatomic subtype and impact adversely upon hospital resource utilization.
本研究旨在确定心律失常对单心室（SV）先天性心脏病（CHD）成人住院情况的影响。
外科手术的进展显著提高了CHD患者的生存率。心律失常和心源性猝死在CHD成人患者中很常见。
利用2004年至2011年儿科健康信息系统数据库中43家儿科医院的数据，确定年龄≥18岁、因国际疾病分类第九版编码诊断为左心发育不全综合征（HLHS）、三尖瓣闭锁（TA）或共同心室（CV）且伴有心律失常而入院的患者。确定了主要和次要诊断、住院时间（LOS）、住院费用和介入程序。使用多水平模型评估3个亚组（HLHS、TA和CV）在人口统计学、诊断和临床结局方面的差异。使用方差分析检查费用与心律失常及入院年份之间的相互作用。424例患有SV CHD且诊断为心律失常的患者中有642次入院。454次入院（71%）存在单一心律失常诊断。住院总费用为8070万美元，每次入院平均费用为127296美元±243094美元。平均每日住院费用为16653美元±17516美元，且在研究期间有所增加（P<0.01）。心律失常分布受SV解剖亚型影响（P<0.001）。心律失常组之间的医院资源利用存在显著差异（P<0.001）。
在患有SV CHD的成人中，心律失常受SV解剖亚型影响，并对医院资源利用产生不利影响。
