Children's Mercy Kansas City Kansas City MO.
University of Missouri-Kansas City Kansas City MO.
J Am Heart Assoc. 2023 Dec 5;12(23):e031069. doi: 10.1161/JAHA.123.031069. Epub 2023 Nov 28.
Despite improvements in survival over time, the mortality rate for infants with single-ventricle heart disease remains high. Infants of low socioeconomic status (SES) are particularly vulnerable. We sought to determine whether use of a novel remote monitoring program, the Cardiac High Acuity Monitoring Program, mitigates differences in outcomes by SES.
Within the Cardiac High Acuity Monitoring Program, we identified 610 infants across 11 centers from 2014 to 2021. All enrolled families had access to a mobile application allowing for near-instantaneous transfer of patient information to the care team. Patients were divided into SES tertiles on the basis of 6 variables relating to SES. Hierarchical logistic regression, adjusted for potential confounding characteristics, was used to determine the association between SES and death or transplant listing during the interstage period. Of 610 infants, 39 (6.4%) died or were listed for transplant. In unadjusted analysis, the rate of reaching the primary outcome between SES tertiles was similar (=0.24). Even after multivariable adjustment, the odds of death or transplant listing were no different for those in the middle (odds ratio, 1.7 [95% CI, 0.73-3.94) or highest (odds ratio, 0.997 [95% CI, 0.30, 3.36]) SES tertile compared with patients in the lowest (overall value 0.4).
In a large multicenter cohort of infants with single-ventricle heart disease enrolled in a digital remote monitoring program during the interstage period, we found no difference in outcomes based on SES. Our study suggests that this novel technology could help mitigate differences in outcomes for this fragile population of patients.
尽管随着时间的推移，单心室心脏病患儿的生存率有所提高，但死亡率仍然很高。社会经济地位（SES）较低的婴儿尤其脆弱。我们试图确定使用一种新型远程监测计划——心脏高敏监测计划是否可以减轻 SES 差异对预后的影响。
在心脏高敏监测计划中，我们从 2014 年到 2021 年在 11 个中心确定了 610 名婴儿。所有入组家庭都可以使用移动应用程序，几乎可以立即将患者信息传输给护理团队。患者根据 SES 相关的 6 个变量分为 SES 三分位数。使用分层逻辑回归，调整潜在的混杂特征，来确定 SES 与中间期死亡或移植列表之间的关联。在 610 名婴儿中，有 39 名（6.4%）死亡或被列入移植名单。在未调整的分析中，SES 三分位数之间达到主要结局的比率相似（=0.24）。即使在多变量调整后，中间（比值比，1.7 [95%CI，0.73-3.94）或最高 SES 三分位数（比值比，0.997 [95%CI，0.30，3.36]）的死亡或移植列表的可能性与最低 SES 三分位数的患者相比没有差异（总体 值 0.4）。
在一项大型多中心队列研究中，我们在中间期期间对患有单心室心脏病的婴儿进行了数字远程监测计划，未发现 SES 与结局之间存在差异。我们的研究表明，这项新技术可能有助于减轻这一脆弱患者群体的预后差异。
