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Optimizing Adult Congenital Heart Disease care: Experience of an organized program in a remote non specialist center
Session:
Posters (Sessão 3 - Écran 1) - Cardiopatias Congénitas no Adulto
Speaker:
Fabiana Duarte
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.2 Congenital Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Fabiana Silva Duarte; André Viveiros Monteiro; Emília Santos; m. Inês Barradas; Luís Oliveira; Cátia Serena; António Fontes; Carina Machado; Raquel Dourado; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins
Abstract
<p>Background: The prevalence and long-term survival of patients with adult congenital heart disease (ACHD) is increasing due to advances in medical, surgical and percutaneous interventions. Recent European recommendations suggested stratification of patient care in three levels in which some patients can be followed in non-specialist centers.<br /> <br /> Objectives: To assess the experience of an ACHD program in a non-specialist center at an ultra-peripheral region. We analysed the allocated resources, complexity of congenital defects, baseline clinical features and clinical outcomes during the follow-up period.<br /> <br /> Methods: Retrospective analysis of consecutive patients with CHD between February 2007 and December 2021, with a median follow-up period of 62 months (IQR 33.5 – 116.5).<br /> <br /> Results: 97 patients were identified, 56.7% female and with a median age of 28 years (IQR 23 – 36). Patients were referred from paediatric cardiology (69.1%), general cardiology (14.4%) and general practitioner (9.3%). Mean age at the time of referral was of 20 ± 12 years.<br /> There were more patients with moderate (48.5%) or mild congenital disease (35.1%) vs severe defects (13.4%). The two main diagnosis in mild category were repaired atrial septal defects (23.5%) and bicuspid aortic valve (29.4%); in the moderate category, Fallot tetralogy (21.3%) and coarctation of the aorta (21.3%); and in the severe category transposition of the great arteries and pulmonary atresia (both representing 46.2%). No gender-related differences were demonstrated (p=0.71). A neonatal diagnosis was made in 40.2% and 22 patients (22.7%) were diagnosed at adulthood. A neurodevelopmental disorder was diagnosed in 16 patients, half with Down’s syndrome. Fifty-two patients (53.6%) underwent at least one surgical procedure, of which 88.5% during childhood and additional percutaneous intervention was required in 7 patients. During follow-up, 4.1% of patients were at NYHA class III/IV, 10.3% had arrhythmic events and 7.2% were hospitalized for heart failure decompensation. Pregnancy occurred in 17 patients and 2% had a cardiac complication. Three patients had an infective endocarditis (2 with severe defects, p 0.049; r=0.2). Only 1 patient died of a non cardiac cause.<br /> <br /> Conclusion: An organized follow-up of ACDH patients in a non-specialist center is possible for most types of mild and moderate congenital defects with a low rates of adverse outcomes. The increasing number of ACHD patients should encourage more peripheric centers to create ACHD programs in close relation with specialist centers.</p>
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