Department of Cardiology, Juntendo University Hospital, Tokyo, Japan; Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
J Cardiol. 2020 Jan;75(1):105-109. doi: 10.1016/j.jjcc.2019.06.010. Epub 2019 Aug 14.
The emerging burden and need of hospital admission due to adult congenital heart disease (ACHD) will need many facilities with expertise in ACHD. Regional specialized ACHD centers are carrying this increasing patient burden. Although these centers are considered to perform better management than other institutes, their impact on outcome has not been fully evaluated.
We used the Japanese Registry of All cardiac and vascular Diseases (JROAD) and the JROAD Diagnosis Procedure Combination (DPC)/Per Diem Payment System dataset and certification data. We only analyzed adult (≥15 years old) patients with ACHD, defined by the International Classification of Diseases, Tenth Revision, diagnosis codes, between April 1, 2013, and March 31, 2014. We defined a "minimal essential regional ACHD (MER-ACHD) center" as an education institute accredited by adult and pediatric cardiology societies. The primary outcome is 30-day mortality. We investigated the impact of MER-ACHD centers on 30-day mortality by using generalized estimating equations.
Of the 538 hospitals registered at JROAD that agreed to participate in the DPC discharge database study, 65 (12.1%) were MER-ACHD centers. Of 4818 patients (46.8% male; age, 50.1±21.4 years), 45.5% were admitted to a MER-ACHD center. Nearly half (48.1%) of the admissions were cases of atrial septal defect, followed by ventricular septal defect, tetralogy of Fallot, and congenital insufficiency of the aortic valve or bicuspid aortic valve. Multivariate analysis revealed a negative impact of emergency admission [1.051 (1.042-1.061)] and a positive impact of MER-ACHD centers [0.986 (0.973-0.999)] on 30-day mortality after adjustment of disease severity.
We noted the impact of MER-ACHD centers on 30-day mortality. Further investigation is needed to establish appropriate regional ACHD center criteria to deliver appropriate ACHD management.
成人先天性心脏病（ACHD）导致的住院负担和需求不断增加，需要许多专业治疗 ACHD 的医疗机构。区域性专门的 ACHD 中心正在承担这一不断增加的患者负担。尽管这些中心被认为能够比其他机构更好地进行管理，但它们对结果的影响尚未得到充分评估。
我们使用了日本所有心血管疾病注册（JROAD）和 JROAD 诊断程序组合（DPC）/按日支付系统数据集和认证数据。我们仅分析了 2013 年 4 月 1 日至 2014 年 3 月 31 日期间患有 ACHD 的成年（≥15 岁）患者，其定义为国际疾病分类，第十次修订版，诊断代码。我们将“最小基本区域 ACHD（MER-ACHD）中心”定义为成人和儿科心脏病学会认可的教育机构。主要结果是 30 天死亡率。我们使用广义估计方程研究了 MER-ACHD 中心对 30 天死亡率的影响。
在同意参与 DPC 出院数据库研究的 JROAD 登记的 538 家医院中，有 65 家（12.1%）是 MER-ACHD 中心。在 4818 名患者中（46.8%为男性；年龄为 50.1±21.4 岁），45.5%被收入 MER-ACHD 中心。近一半（48.1%）的入院病例为房间隔缺损，其次是室间隔缺损、法洛四联症和主动脉瓣或二尖瓣关闭不全。多变量分析显示，在调整疾病严重程度后，急诊入院[1.051（1.042-1.061）]和 MER-ACHD 中心[0.986（0.973-0.999）]对 30 天死亡率有负面影响。
我们注意到 MER-ACHD 中心对 30 天死亡率的影响。需要进一步的研究来建立适当的区域 ACHD 中心标准，以提供适当的 ACHD 管理。
