Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Cancer/Advanced Adult Nursing, Department of Nursing, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
J Cardiol. 2021 Jan;77(1):17-22. doi: 10.1016/j.jjcc.2020.06.018. Epub 2020 Oct 24.
In the treatment of adult congenital heart disease (ACHD), the transfer of patients from pediatric cardiologists to ACHD cardiologists is of relevance. However, little is known about the clinical courses of ACHD patients that have been referred by non-CHD-specialized doctors (n-CSDs).
This retrospective cohort study included 230 patients (average age: 37 ± 15.2 years, male: 97) who were referred to a single specialized ACHD center between April 2016 and July 2019. We compared the characteristics and clinical courses between patients referred by n-CSDs and those referred by CHD-specialized-doctors (CSDs).
Overall, 121 (53%) patients were referred by n-CSDs. Among them, 91 (75%) patients were referred by adult cardiologists. Univariate analysis showed that the patients referred by n-CSDs were older than those referred by CSDs (41.6 ± 16.3 vs. 32.0 ± 12.0 years, p < 0.01), were more likely to have simple CHD, and less likely to have severe CHD (27.0% vs. 12.8% and 16.5% vs. 40.4%, respectively, p < 0.01). Patients referred by n-CSDs were also more likely to have a history of loss of follow-up (16.5% vs. 3.7%, p < 0.01) and to require invasive treatments after referral, including cardiac surgeries and transcatheter interventions (47.9% vs. 26.6 %, p < 0.01). Notably, unintended invasive treatments that were not designated by the referring doctors were more frequently required in patients with moderate complexity referred by n-CSDs (50.0% vs. 23.3%, p = 0.02).
Patients with moderate CHD complexity referred by n-CSDs are more likely to require unintended invasive treatments. Referrals to specialized ACHD centers may be most beneficial for these patients.
在成人先天性心脏病（ACHD）的治疗中，患者从儿科心脏病专家转移到 ACHD 心脏病专家具有重要意义。然而，对于由非心脏病专科医生（n-CSD）转诊的 ACHD 患者的临床过程知之甚少。
本回顾性队列研究纳入了 2016 年 4 月至 2019 年 7 月期间转诊至单一专门的 ACHD 中心的 230 例患者（平均年龄：37±15.2 岁，男性：97 例）。我们比较了 n-CSD 和心脏病专科医生（CSD）转诊患者的特征和临床过程。
总体而言，有 121 例（53%）患者由 n-CSD 转诊。其中，91 例（75%）患者由成人心脏病专家转诊。单因素分析显示，n-CSD 转诊患者的年龄大于 CSD 转诊患者（41.6±16.3 岁 vs. 32.0±12.0 岁，p<0.01），更有可能患有简单型 CHD，且不太可能患有严重 CHD（分别为 27.0% vs. 12.8%和 16.5% vs. 40.4%，p<0.01）。n-CSD 转诊患者也更有可能有失访史（16.5% vs. 3.7%，p<0.01），转诊后更需要进行有创治疗，包括心脏手术和经导管介入治疗（47.9% vs. 26.6%，p<0.01）。值得注意的是，n-CSD 转诊的中度复杂患者更常需要非转诊医生指定的意外有创治疗（50.0% vs. 23.3%，p=0.02）。
n-CSD 转诊的中度复杂 CHD 患者更有可能需要意外的有创治疗。将患者转至专门的 ACHD 中心可能对这些患者最有益。
