Mohan Shaun, Moffett Brady S, Lam Wilson, de la Uz Caridad, Miyake Christina, Valdes Santiago O, Kim Jeffrey J
Division of Pediatric Cardiology, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky, USA.
Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Congenit Heart Dis. 2017 Jul;12(4):507-511. doi: 10.1111/chd.12478. Epub 2017 May 22.
As survivors of congenital heart disease (CHD) continue to age, healthcare utilization by this population has increased. It is unknown how often these patients utilize the emergency department (ED) at children's hospitals and how arrhythmias play a role in their utilization of care.
Using a retrospective cohort design, the Pediatric Hospital Information System (PHIS) database was investigated and we studied adults (≥18 years) with CHD (ACHD) who presented to pediatric EDs from 2004 to 2014.
Tertiary care pediatric hospitals.
Of the 6310 encounters to pediatric EDs, 1594 (25%) were for arrhythmias. The median age was 21 years (IQR 19.1-25.1). The most common tachyarrhythmia diagnoses during the study period were atrial flutter (32%), atrial fibrillation (15%), and paroxysmal VT (10%). Bradyarrhythmias represented a minority of total arrhythmias. Presentation with arrhythmias was associated with an increased risk of admission, ICU care, and death (P < .01). Arrhythmias are also highly associated with CHD severity with twice as many complex CHD having arrhythmias compared to simple CHD (P < .01).
Total admissions of adults with CHD from the ED of children's hospitals have increased over time while the transfers to outside facilities remain consistently low. While the population of ACHD continues to grow, utilization of pediatric EDs for this cohort has increased. Adults with higher CHD complexity are more likely to present with clinical arrhythmias but there is a growing number of ACHD patients with simple complexity presenting with arrhythmias in recent years. ACHD patients that present with arrhythmias are at increased risk of morbidity and mortality.
随着先天性心脏病（CHD）幸存者年龄的不断增长，这一人群的医疗服务利用率有所上升。目前尚不清楚这些患者在儿童医院急诊科（ED）就诊的频率，以及心律失常在他们的医疗服务利用中扮演何种角色。
采用回顾性队列设计，对儿科医院信息系统（PHIS）数据库进行调查，我们研究了2004年至2014年期间前往儿科急诊科就诊的成年先天性心脏病患者（ACHD，年龄≥18岁）。
三级医疗儿科医院。
在6310次儿科急诊科就诊中，1594次（25%）是因心律失常。中位年龄为21岁（四分位间距19.1 - 25.1岁）。研究期间最常见的快速性心律失常诊断为心房扑动（32%）、心房颤动（15%）和阵发性室性心动过速（10%）。缓慢性心律失常占心律失常总数的少数。心律失常的出现与入院、重症监护病房治疗及死亡风险增加相关（P < 0.01）。心律失常也与CHD严重程度高度相关，复杂CHD患者发生心律失常的人数是简单CHD患者的两倍（P < 0.01）。
随着时间的推移，儿童医院急诊科成年CHD患者的总入院人数有所增加，而转至外部机构的人数一直较低。虽然ACHD人群持续增长，但该队列对儿科急诊科的利用率有所上升。CHD复杂性较高的成年人更有可能出现临床心律失常，但近年来，越来越多复杂性较低的ACHD患者也出现了心律失常。出现心律失常的ACHD患者发病和死亡风险增加。
