Adult hospitalizations for congenital heart disease increasing, researchers find

Jared M. O'Leary, M.D., of Brigham and Women's Hospital, Boston, and colleagues analyzed U.S. hospitalizations from 1998 through 2010 for children and adults with congenital heart disease. "There are more than 787,000 adults with congenital heart disease in the United States. Adults with congenital heart disease remain at risk for frequent hospitalizations," the authors write in a Research Letter published online by JAMA to coincide with its presentation at the American College of Cardiology's annual Scientific Sessions.

The researchers identified congenital heart disease admissions to acute care hospitals from 1998 through 2010 using the Nationwide Inpatient Sample, a stratified 20 percent sample of hospitalizations, including approximately 8 million admissions annually from approximately 1,000 hospitals. The primary outcome was the change in number of admissions for all congenital heart disease diagnoses for pediatric (less than 18 years of age) vs. adult patients. To minimize the effect of year-to-year variability, the number of hospitalizations were compared between the first and second halves of the study (January 1998 through June 2004; July 2004 through December 2010).

The authors found that the frequency of hospitalizations for adults with congenital heart disease has grown at a rate more than twice that for children. Adult admission volume was 87.8 percent higher during the second half of the study (n = 622,084) compared with the first half (n = 331,162), while pediatric admissions grew 32.8 percent (1,082,540 vs. 815,471). Adults accounted for 36.5 percent of congenital heart disease admissions in the latter era, up from 28.9 percent.

"The observed trend is likely due to a number of independent forces including better congenital heart disease survival, an aging population, and accumulating comorbidities. Limited availability of quality outpatient services may also contribute," the researchers write. "Adult congenital heart disease admissions will have an increasing impact on resource utilization. Further research and focus on optimizing health care delivery is warranted to effectively care for adults with congenital heart disease."
(doi:10.1001/jama.2013.564; Available pre-embargo to the media at http://media.jamanetwork.com)