title: Transfer of adolescents with congenital heart disease from pediatric cardiology to adult health care: an analysis of transfer destinations.
abstract: OBJECTIVE
  The transfer of adolescents with congenital heart disease from pediatric to adult care was examined. The aims were to investigate where these adolescents received adult-centered care, to determine the proportion of patients with no follow-up and with no appropriate follow-up after leaving pediatric cardiology, and to explore the determinants of no follow-up and no appropriate follow-up.
  
  
  BACKGROUND
  Even after successful treatment, many patients require lifelong cardiac surveillance by specialized practitioners. Although guidelines describe the most appropriate level of follow-up, this is not always implemented in practice.
  
  
  METHODS
  A descriptive, observational study was performed, including 794 patients with congenital heart disease examined and/or treated at a tertiary care center.
  
  
  RESULTS
  Overall, 58 of the 794 patients included (7.3%) were not in follow-up. Cessation of follow-up was found in 2 of 74 patients with complex (2.7%), 31 of 448 patients with moderate (6.9%), and 25 of 272 patients with simple (9.2%) heart defects. Moreover, 684 patients (86.1%) remained in specialized follow-up. According to international guidelines, 81 patients (10.2%) did not receive the minimal level of cardiac care. Multivariable logistic regression revealed that male sex and no prior heart surgery were associated with no follow-up. Male sex, no prior heart surgery, and greater complexity of congenital heart disease were associated with no appropriate level of cardiac follow-up.
  
  
  CONCLUSIONS
  The proportion of patients in this study lost to follow-up was substantially lower than in other Western countries. Because only patient-related factors were examined with respect to loss to follow-up, further examination of patient-related, hospital-related, and healthcare-related determinants of lack of follow-up is needed.
authors.affiliation: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Eva
authors.initials: E
authors.lastname: Goossens
authors.forename: Ine
authors.initials: I
authors.lastname: Stephani
authors.forename: Deborah
authors.initials: D
authors.lastname: Hilderson
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.forename: Kristien
authors.initials: K
authors.lastname: Van Deyk
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
mesh_terms: D000293:Adolescent; D002309:Cardiology; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010372:Pediatrics; D055815:Young Adult