Emergency admissions in Asians with adult congenital heart disease.
OBJECTIVE
In the area of acute emergency care, the needs of adult congenital heart disease patients (ACHD) are unique and burden on hospital resources are likely substantial. We aim to understand the reasons for emergency admissions and associations of increased hospital length of stay (LOS).


METHODS
We evaluated 600 ACHD patients in our adult congenital database. Patients who required emergency admissions between January 2007 and December 2007 were studied from hospital records.


RESULTS
Sixty-eight ACHD patients (11%) required emergency admissions, culminating in a total of 108 admissions. Mean age was 37.6 years (SD 18.0), with a female preponderance (56%). Most were either schooling or working (62%) and were single (62%). Atrial septal defect (24%), ventricular septal defect (19%) and tetralogy of fallot (13%) formed the majority of diagnoses, mirroring proportions in our cohort. A third of the admissions were for cardiac reasons including arrhythmia, heart failure, endocarditis, and thromboembolism; the remaining two-thirds were for non-cardiac reasons. Median hospital LOS was 5.0 days. Those who were older (p=0.02) and neither employed nor schooling (p=0.021) had longer LOS. Thromboembolism accounted for longer LOS (p=0.047). One-third of the admissions that required interdisciplinary referrals had increased LOS (p<0.001), with utilization of non-cardiac investigations (p=0.002). Increased LOS was not associated with adverse clinical outcome (p=0.68).


CONCLUSIONS
ACHD patients require emergency admissions for both cardiac and non-cardiac reasons. Older age groups, unemployment and thromboembolic complications were associated with increased LOS. Non-cardiac conditions required interdisciplinary resources and were associated with increased LOS. Understanding their diverse acute needs may potentially improve care and outcome for these patients.
Koh
Angela S
AS
Department of Cardiology, National Heart Centre, Singapore, Singapore. angela.koh.s.m@singhealth.com.sg
Yap
Betty T
BT
Le Tan
Ju
J
D000328:Adult; D017677:Age Distribution; D044466:Asian People / Q000706:statistics & numerical data*; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000208:ethnology* / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012846:Singapore / Q000453:epidemiology; D013923:Thromboembolism / Q000208:ethnology / Q000628:therapy; D055815:Young Adult