Transfer of Adolescents With Congenital Heart Disease From Pediatric Cardiology to Adult Health Care: An Analysis of Transfer Destinations

Study Questions:

At what rates are adolescents leaving pediatric cardiology lost to follow-up, and what level of care do they receive after transfer to adult care?

Methods:

A descriptive, observational study was performed at a single tertiary center.

Results:

A total of 794 patients were studied, of which 58 (7.3%) were lost to follow-up. Of the 74 patients with complex heart defects, two (2.7%) were lost to follow-up, as compared with 31 of 448 patients with moderate (6.9%), and 25 of 272 patients with simple defects (9.2%). When international guidelines were applied, 10.2% of patients were not receiving the minimal recommended level of cardiac care. Male sex and no previous cardiac surgery were associated with lack of cardiac follow-up.

Conclusions:

The authors concluded that the proportion of patients lost to follow-up was lower than that previously reported in other countries.

Perspective:

This study confirms previous studies demonstrating that patients are less likely to be lost to follow-up if they have severe forms of congenital heart disease. The study showed a significantly higher rate of successful transfer than has been previously reported. Reid et al. (Pediatrics, 2004) reported a successful transfer rate of 47% in Canada, despite universal health insurance coverage and mandatory transfer upon reaching adulthood. A further understanding of practices at centers with high successful transfer rates will be important to minimize lost-to-follow-up at other centers. Additionally, it is interesting to note that the center involved with the current study had a well-established policy for transfer of patients to adult care, but no formal transition program.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Congenital Heart Disease, CHD & Pediatrics and Quality Improvement

Keywords: Follow-Up Studies, Heart Defects, Congenital, Pediatrics, Cardiology, Canada, Lost to Follow-Up


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