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. 1999 Jan;81(1):57–61. doi: 10.1136/hrt.81.1.57

Outpatient clinics for adults with congenital heart disease: increasing workload and evolving patterns of referral

M Gatzoulis 1, S Hechter 1, S Siu 1, G Webb 1
PMCID: PMC1728911  PMID: 10220546

Abstract

Objective—To examine the evolving role of specialised outpatient services for adult patients with congenital heart disease.
Design—A retrospective analysis of all patients attending the Toronto Congenital Cardiac Centre for Adults over three corresponding three month periods in 1987, 1992, and 1997.
Setting—A tertiary referral centre.
Main outcome measures—Patient demographics, residence, medical and surgical history, type and source of referral, and investigations performed.
Results—In all, 570 patients were seen at the clinic during these three periods. There was a 44% and a 269% increase in workload between 1987 to 1992 and 1992 to 1997, respectively. There was a steady fall in mean age of patients seen at the clinic with time (38.5, 33.6, and 31.7 years in 1987, 1992, and 1997, respectively, p < 0.001). New referrals from community cardiologists and family physicians increased more in relative terms than did referrals from the Hospital for Sick Children, Toronto (6.7%, 15%, and 37.5%, p = 0.02). There was a steady increase in patients with previous reparative surgery (48.9%, 59.2%, and 69.2%, p < 0.002). The proportion of patients with previous reoperations also increased (2.3%, 10%, and 9.2%, p < 0.01). Echocardiography remained the predominant method of diagnosis. The diagnostic mix did not change with time.
Conclusions—Over the past 10 years there has been a large increase in adults with congenital heart disease requiring and seeking specialised care in a tertiary health centre, with a concomitant evolution of referral patterns. These data may be helpful in planning of similar paediatric and adult cardiac services for this expanding population.

 Keywords: congenital heart disease;  ambulatory clinics

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Figure 1  .

Figure 1  

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Patients seen at the TCCCA clinic during the same three month period in 1987, 1992, and 1997. Notice 44% and 269% increase between 1987 and 1992, and 1992 and 1997, respectively.

Figure 2  .

Figure 2  

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Surgical profile of patients at the time of their clinic visit. Notice significant increase between 1987 and 1997 in the percentage of patients with previous reparative surgery and in those who required reoperations after initial repair.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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