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Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

Lookup NU author(s): Dr Louise Coats, Dr Bill ChaudhryORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2022 by the authors. Licensee MDPI, Basel, Switzerland.Background: The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. Methods: A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, median ACHD AP class 2B) between 2014 and 2019 and the COVID-19 restrictions period (March 2020–July 2021). Results: Between 2014 and 2019, there were 575 appointments. Nonatten-dance was 10%; 15 patients recurrently nonattended. Eighty percent of appointments resulted in no decision other than continued review. Electrocardiograms and echocardiograms were frequent, but new findings were rare (5.1%, 4.0%). Decision-making was more common with the higher ACHD AP class and symptoms. Emergency admissions (n = 40) exceeded elective (n = 25), with over half following unremarkable clinic appointments. Distance travelled to the ACHD clinic was 14.9 km (1.6–265), resulting in 433–564 workdays lost. During COVID 19, there were 127 appointments (56% in-person, 41% telephone and 5% video). Decisions were made at 37% in-person and 19% virtual consultations. Nonattendance was 3.9%; there were eight emergency admissions. Conclusion: The main purpose of the ACHD clinic is surveillance. Presently, the clinic does not sufficiently predict or prevent emergency hospital admissions and is costly to patient and provider. COVID-19 has enforced different methods for delivering care that require further evaluation.

Publication metadata

Author(s): Coats L, Chaudhry B

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Medicine

Year: 2022

Volume: 11

Issue: 7

Online publication date: 06/04/2022

Acceptance date: 03/04/2022

Date deposited: 13/02/2024

ISSN (electronic): 2077-0383

Publisher: MDPI

URL: https://doi.org/10.3390/jcm11072058

DOI: 10.3390/jcm11072058

Data Access Statement: Data is available from the authors on request

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