期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 10, 期 4, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.120.018286
关键词
congenital heart disease; mortality; resource utilization
资金
- Cardiac Center Clinical Research Core at the Children's Hospital of Philadelphia
- NIH [K01HL125521]
- Pulmonary Hypertension Society
Children admitted with congenital heart disease (CHD) have seen an increasing trend in hospital admissions, charges, and mortality rates over the past decade. Despite a decrease in mortality rates among CHD admissions, they are still significantly higher than those without CHD, and CHD patients account for a growing proportion of all pediatric inpatient deaths. Effective resource allocation is essential to improve outcomes for these high-risk patients.
Background Children with congenital heart disease (CHD) are known to consume a disproportionate share of resources, yet there are limited data concerning trends in resource use and mortality among admitted children with CHD. We hypothesize that charges in CHD-related admissions increased but that mortality improved over time. Methods and Results This study, including patients <18 years old with CHD, examined inpatient admissions from the nationally representative Kids' Inpatient Database from 2003 to 2016 in order to assess the frequency, medical complexity, and outcomes of CHD hospital admissions. A total of 859 843 admissions of children with CHD were identified. CHD admissions increased by 31.8% from 2003 to 2016, whereas overall pediatric admissions decreased by 13.4%. Compared with non-CHD admissions, those with CHD were more likely to be <1 year of age (80.5% versus 63.3%), and to have >= 1 complex chronic condition (39.7% versus 9.3%). For CHD admissions, mortality was higher (2.97% versus 0.31%) and adjusted median charges greater ($48 426 [interquartile range (IQR), $11.932-$161 048] versus $4697 [IQR, $2551-$12 301]) (P<0.0001 for all). Among CHD admissions, whereas adjusted median charges increased from $35 577 (IQR, $9303-$110 439) to $61 696 (IQR, $15 212-$219 237), mortality decreased from 3.2% to 2.7% (P for trend <0.0001). CHD admissions accounted for an increased proportion of all inpatient deaths, from 18.0% in 2003 to 24.5% in 2016. Conclusions Children admitted with CHD are 10 times more likely to die than those without CHD and have higher charges. Although the rate of mortality in CHD admissions decreased, children with CHD accounted for an increasing proportion of all pediatric inpatient deaths. Effective resource allocation is critical to optimize outcomes in these high-risk patients.
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