Author + information
- Benjamin Zielonka,
- Michael Liu,
- Brian Snarr,
- Xuemei Zhang and
- Jack Rychik
Background: Single ventricle cardiac defects (SVCD) require the highest neonatal expenditures of any congenital birth defect. Advances in prenatal diagnosis have facilitated prenatal and perinatal management of SVCD, but little is known about the total resources required to care for a patient from fetal diagnosis through Fontan palliation (FP). We sought to characterize the resource utilization for patients with SVCD from fetal diagnosis through death, complete staged palliation, or transplant.
Methods: We reviewed patients with a prenatal diagnosis of SVCD from 2004-2012. Only patients delivered with intent to treat who received cardiac care exclusively at our institution were included. Patients undergoing staged repair were followed until death or 6 months post-FP. Transplant recipients and patients who did not complete FP at the time of data collection were censored at 3.43 years. Primary endpoints included the total number of days hospitalized, number of echocardiograms, and total cardiac catheterizations, expressed in patient-years. The resource utilization of patients who survived and died during the period of staged repair were then compared using negative binomial regression.
Results: A cohort of 204 patients met inclusion criteria. 154 (75.5%) patients survived and 50 (24.5%) died during the study period. The median duration of follow-up was 3.23 years. The median days hospitalized per patient-year was 23.24. The median number of echocardiograms and catheterizations per patient-year was 6.70 and 0.76 respectively. Death during staged repair was associated with a greater resource burden. Patients who died spent more days hospitalized per patient-year (332.09 vs. 16.51; p<.0001), and had more echocardiograms (51.06 vs. 5.75; p<.0001) and catheterizations per patient-year (3.94 vs. 0.66; p<.0001).
Conclusions: Our study quantifies the specific resources used from fetal diagnosis through the period of staged repair. Mortality during staged repair was associated with disproportionate resource utilization. Further investigation into prenatal determinants of resource utilization will enable more comprehensive counseling for expectant families of patients with SVCD.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Heart Disease: Innovations in Single Ventricle Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1182-019
- 2017 American College of Cardiology Foundation