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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Trends in Hospitalizations for Adults With Congenital Heart Disease in the U.S.

Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

Manuscript received January 7, 2009; revised manuscript received March 13, 2009, accepted April 13, 2009.

^_* Reprint requests and correspondence: Dr. Alexander R. Opotowsky, Children's Hospital Boston, Boston Adult Congenital Heart Program, 300 Longwood Avenue, Boston, Massachusetts 02115 (Email: alexander.opotowsky{at}childrens.harvard.edu).

Objectives: The purpose of this study was to better define the epidemiology of hospitalizations for adults with congenital heart disease (ACHD) in the U.S.

Background: There is a growing population of ACHD as the result of advances in pediatric care and diagnostic testing.

Methods: We used nationally representative data from the 1998 to 2005 Nationwide Inpatient Sample to identify patients 18 years of age admitted to an acute care hospital with an International Classification of Diseases-9th Revision code designating a CHD diagnosis. National estimates of hospitalizations and total hospital charges by year were calculated.

Results: The number of ACHD hospitalizations increased 101.9% from 35,992 ± 2,645 in 1998 to 72,656 ± 5,258 in 2005. During this period, the annual number of admissions grew for both simple (19,448 ± 1,614 to 44,707 ± 3,644) and complex (12,507 ± 1,172 to 19,973 ± 1,624) diagnoses. The percentage of admissions originating in the emergency department (41.7 ± 0.8%) or involving cardiac surgery (17.7 ± 0.7%) remained stable during the study period. The average patient age (52.3 ± 0.8 years to 53.8 ± 0.6 years, p < 0.0001) and proportion of patients with 2 medical comorbidities (23.3 ± 0.9% to 33.0 ± 0.7%, p < 0.0001) increased. Mean hospital charges per hospitalization increased 127% from $19,186 ± $803 to $43,496 ± $2,166, and the estimated total national charges for these hospitalizations increased 357% from $691 million in 1998 to $3.16 billion in 2005 (in inflation-adjusted 2005 dollars).

Conclusions: The number of hospital admissions for ACHD in the U.S. more than doubled between 1998 and 2005. Hospital charges attributable to these admissions have grown even more dramatically.

Key Words: congenital heart disease • adults • epidemiology • hospitalization • cardiac surgery

Abbreviations and Acronyms   ACHD = adult congenital heart disease   ASD = atrial septal defect   ED = emergency department   ICD-9 = International Classification of Diseases-9th Revision   LOS = length of stay   NIS = Nationwide Inpatient Sample   PFO = patent foramen ovale

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