Clinical Operational Research Unit, UCL, London, UK.
Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK.
Heart. 2022 Nov 24;108(24):1964-1971. doi: 10.1136/heartjnl-2022-321085.
This study assessed the transfer of patients from paediatric cardiac to adult congenital heart disease (ACHD) services in England and the factors impacting on this process.
This retrospective cohort study used a population-based linked data set (LAUNCHES QI data set: 'Linking Audit and National datasets in Congenital Heart Services for Quality Improvement') including all patients born between 1987 and 2000, recorded as having a congenital heart disease (CHD) procedure in childhood. Hospital Episode Statistics data identified transfer from paediatric to ACHD services between the ages of 16 and 22 years.
Overall, 63.8% of a cohort of 10 298 patients transferred by their 22nd birthday. The estimated probability of transfer by age 22 was 96.5% (95% CI 95.3 to 97.7), 86.7% (95% CI 85.6 to 87.9) and 41.0% (95% CI 39.4 to 42.6) for severe, moderate and mild CHD, respectively. 166 patients (1.6%) died between 16 and 22 years; 42 of these (0.4%) died after age 16 but prior to transfer. Multivariable ORs in the moderate and severe CHD groups up to age 20 showed significantly lower likelihood of transfer among female patients (0.87, 95% CI 0.78 to 0.97), those with missing ethnicity data (0.31, 95% CI 0.18 to 0.52), those from deprived areas (0.84, 95% CI 0.72 to 0.98) and those with moderate (compared with severe) CHD (0.30, 95% CI 0.26 to 0.35). The odds of transfer were lower for the horizontal compared with the vertical care model (0.44, 95% CI 0.27 to 0.72). Patients who did not transfer had a lower probability of a further National Congenital Heart Disease Audit procedure between ages 20 and 30 compared with those who did transfer: 12.3% (95% CI 5.1 to 19.6) vs 32.5% (95% CI 28.7 to 36.3).
Majority of patients with moderate or severe CHD in England transfer to adult services. Patients who do not transfer undergo fewer elective CHD procedures over the following decade.
本研究评估了英格兰儿科心脏到成人先天性心脏病（ACHD）服务的患者转归情况，以及影响这一过程的因素。
本回顾性队列研究使用了基于人群的关联数据集（LAUNCHES QI 数据集：“在先天性心脏病服务中链接审核和国家数据集以进行质量改进”），其中包括所有 1987 年至 2000 年期间出生的患者，记录为儿童时期患有先天性心脏病（CHD）手术。医院发病统计数据确定了 16 至 22 岁之间从儿科到 ACHD 服务的转归。
总体而言，队列中有 10298 例患者中的 63.8%在 22 岁生日前转归。到 22 岁时转归的估计概率为 96.5%（95%CI 95.3 至 97.7），严重、中度和轻度 CHD 分别为 86.7%（95%CI 85.6 至 87.9）和 41.0%（95%CI 39.4 至 42.6）。166 例患者（1.6%）在 16 至 22 岁之间死亡；其中 42 例（0.4%）在 16 岁后但在转归前死亡。中度和重度 CHD 组直至 20 岁的多变量 OR 显示，女性患者（0.87，95%CI 0.78 至 0.97）、缺失种族数据的患者（0.31，95%CI 0.18 至 0.52）、来自贫困地区的患者（0.84，95%CI 0.72 至 0.98）和患有中度（而非重度）CHD 的患者（0.30，95%CI 0.26 至 0.35）的转归可能性显著降低。水平护理模式与垂直护理模式相比，转归的可能性更低（0.44，95%CI 0.27 至 0.72）。与转归的患者相比，未转归的患者在 20 至 30 岁之间进行国家先天性心脏病审核程序的可能性较低：12.3%（95%CI 5.1 至 19.6）与 32.5%（95%CI 28.7 至 36.3）。
英格兰大多数患有中度或重度 CHD 的患者都转归到成人服务。未转归的患者在接下来的十年中接受的择期 CHD 手术较少。
