Author + information
- Received October 23, 2017
- Revision received February 6, 2018
- Accepted February 7, 2018
- Published online April 16, 2018.
- Andrew S. Mackie, MD, SMa,b,∗ (, )
- Gwen R. Rempel, RN, PhDa,c,
- Adrienne H. Kovacs, PhDd,
- Miriam Kaufman, MDe,f,
- Kathryn N. Rankin, PhDa,
- Ahlexxi Jelen, BA Honse,
- Maryna Yaskina, PhDg,
- Renee Sananes, PhDe,
- Erwin Oechslin, MDd,
- Dimi Dragieva, RNe,
- Sonila Mustafa, RNe,
- Elina Williams, RNb,
- Michelle Schuh, RNb,
- Cedric Manlhiot, PhDe,
- Samantha J. Anthony, PhD, MSWe,
- Joyce Magill-Evans, PhDh,
- David Nicholas, PhDi and
- Brian W. McCrindle, MD, MPHe,f
- aDepartment of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- bStollery Children’s Hospital, Edmonton, Alberta, Canada
- cAthabasca University, Athabasca, Alberta, Canada
- dUniversity Health Network, Peter Munk Cardiac Centre, Toronto Congenital Cardiac Centre for Adults, and University of Toronto, Toronto, Ontario, Canada
- eThe Hospital for Sick Children, Toronto, Ontario, Canada
- fDepartment of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- gWomen and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
- hFaculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- iFaculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- ↵∗Address for correspondence:
Dr. Andrew S. Mackie, Division of Cardiology, Stollery Children’s Hospital, 4C2 Walter C. Mackenzie Center, 8440 112th Street NW, Edmonton, Alberta T6G 2B7, Canada.
Background There is little evidence regarding the efficacy of interventions to prepare adolescents with congenital heart disease (CHD) to enter adult care.
Objectives The goal of this study was to evaluate the impact of a nurse-led transition intervention on lapses between pediatric and adult care.
Methods A cluster randomized clinical trial was conducted of a nurse-led transition intervention for 16- to 17-year-olds with moderate or complex CHD versus usual care. The intervention group received two 1-h individualized sessions targeting CHD education and self-management skills. The primary outcome was excess time to adult CHD care, defined as the interval between the final pediatric and first adult cardiology appointments, minus the recommended time interval, analyzed by using Cox proportional hazards regression accounting for clustering. Secondary outcomes included scores on the MyHeart CHD knowledge survey and the Transition Readiness Assessment Questionnaire.
Results A total of 121 participants were randomized to receive the intervention (n = 58) or usual care (n = 63). At the recommended time of first adult appointment (excess time = 0), intervention participants were 1.8 times more likely to have their appointment within 1 month (95% confidence interval: 1.1 to 2.9; Cox regression, p = 0.018). This hazard increased with time; at an excess time of 6 months, intervention participants were 3.0 times more likely to have an appointment within 1 month (95% confidence interval: 1.1 to 8.3). The intervention group had higher scores at 1, 6, 12, and 18 months on the MyHeart knowledge survey (mixed models, p < 0.001) and the Transition Readiness Assessment Questionnaire self-management index (mixed models, p = 0.032).
Conclusions A nurse-led intervention reduced the likelihood of a delay in adult CHD care and improved CHD knowledge and self-management skills. (Congenital Heart Adolescents Participating in Transition Evaluation Research [CHAPTER 2]; NCT01723332)
This study was funded by a Grant-in-Aid from the Heart and Stroke Foundation of Canada and by the Bridge Funding Program of the Canadian Institutes of Health Research. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 23, 2017.
- Revision received February 6, 2018.
- Accepted February 7, 2018.
- 2018 American College of Cardiology Foundation
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