Agarwal Anushree, Duan Rong, Bayne Joseph, Rudov Lindsey, Mehta Rittal, Phillippi Ruth, Roeder Mark, Saraf Sneha, Kanter Ronald, Jackson Jamie L, Lewis Matthew, Saidi Arwa, Sandhu Satinder, Young Thomas, Jacobsen Roni, Ruckdeschel Emily, Lubert Adam, Singh Harsimran, Zaidi Ali, Halpern Dan G, Leezer Scott, John Anitha S, Carton Thomas
Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
JACC Adv. 2025 Jul 28;4(8):102021. doi: 10.1016/j.jacadv.2025.102021.
Although routine outpatient visits with adult congenital heart defect (ACHD) specialists have been recommended, the evidence to support this remains sparse.
The purpose of this study was to evaluate the association between outpatient ACHD visits and emergent admissions.
This observational study used standardized electronic health record data from 13 health centers from January 1, 2015 through December 31, 2019. Mixed logistic regression analyses examined the effects of number of outpatient ACHD specialist visits (1-2 considered routine) during a 6-month period on an emergent admission in the subsequent 6-month period, after adjusting for cohort characteristics, CHD severity, and center. Analysis was stratified by ACHD anatomic types and medical conditions associated with or without physiological CHD class.
The 16,142 patients (median age 32 years, 44.9% women, 83.2% White) contributed to 118,079 person-periods, an average of 7.3 periods per person. Between 1.3% and 2.7% of patients had one emergent admission per 6-month period. Patients with zero, 3, 4, or more than 4 prior outpatient visits had 1.34, 1.67, 2.08-, and 2.48 times higher odds of emergent admission, respectively, than those with a prior routine visit (P < 0.05 using the Wald test). The stratified adjusted analysis demonstrated similar J-shaped (nonlinear) relationships by presence of medical conditions but not by anatomic type.
Having routine outpatient ACHD specialist visits over a 6-month period reduces the likelihood of an emergent admission in the subsequent period, findings driven by presence of medical conditions and not anatomic severity. These findings provide supporting evidence for the ACHD guidelines and implementation science research.
尽管推荐对成人先天性心脏病（ACHD）患者进行常规门诊就诊，但支持这一做法的证据仍然稀少。
本研究旨在评估门诊ACHD就诊与急诊入院之间的关联。
这项观察性研究使用了来自13个医疗中心2015年1月1日至2019年12月31日的标准化电子健康记录数据。混合逻辑回归分析在调整队列特征、冠心病严重程度和医疗中心后，研究了6个月期间门诊ACHD专科就诊次数（1 - 2次视为常规就诊）对随后6个月内急诊入院的影响。分析按ACHD解剖类型以及与生理性CHD分级相关或不相关的医疗状况进行分层。
16142名患者（中位年龄32岁，44.9%为女性，83.2%为白人）共产生了118079人 - 月的随访期，平均每人7.3个随访期。每6个月期间，1.3%至2.7%的患者有一次急诊入院。之前门诊就诊次数为零、3次、4次或超过4次的患者，急诊入院的几率分别比之前有过常规就诊的患者高1.34倍、1.67倍、2.08倍和2.48倍（使用Wald检验，P < 0.05）。分层调整分析显示，按医疗状况存在与否呈现相似的J形（非线性）关系，但按解剖类型则不然。
在6个月期间进行常规门诊ACHD专科就诊可降低随后时期急诊入院的可能性，这一结果是由医疗状况而非解剖严重程度驱动的。这些发现为ACHD指南和实施科学研究提供了支持证据。
