title: Provision of Transition Education and Referral Patterns from Pediatric Cardiology to Adult Cardiac Care.
abstract: ACC/AHA guidelines recommend a structured preparation for and transfer to adult-oriented cardiac care for adult survivors of pediatric onset heart disease (POHD). Given this, we sought to describe the transition and transfer practices for a cohort of young adults with POHD and to determine factors associated with successful transfer to adult-oriented cardiac care. We performed a single-center, retrospective chart review on patients ≥18 years of age, with POHD likely to require lifelong cardiac care, who were seen in outpatient pediatric cardiology (PC) between 2008 and 2011. Successful transfer was defined as the subsequent attendance at adult cardiology (AC) within 2 years of PC visit. We identified 118 patients who met study criteria. Mean age 22.4 ± 2.0 years, 59 % male, 64 % white and 40 % Hispanic. Mean transition education topics noted was 3.3 ± 1.8 out of 20 and covered the underlying cardiac disease (89 %), follow-up and current medications (56 %) and exercise limitations (34 %). Recommendations for follow-up were AC (57 %) and PC (33 %). Of those told to transfer to AC, 79 % successfully transferred. Characteristics of successful transfer included: prior cardiac surgery (p = 0.008), cardiac medication use (p = 0.006) and frequency of follow-up ≤1 year (p = 0.037). One-quarter of all subjects did not follow-up within at least 2 years. Despite published guidelines, transition education appears lacking and the approach to transfer to adult cardiac care is not consistent. Given the increased risk of morbidity and mortality in this patient population, standardization of transition education and transfer processes appear warranted.
authors.affiliation: Children's Hospital Los Angeles, 4650 Sunset Blvd, #34, Los Angeles, CA, 90027, USA. aharbison@chla.usc.edu.|Stanford University, 750 Welch Rd, Suite 321, Palo Alto, CA, USA. aharbison@chla.usc.edu.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Harbison
authors.affiliation: Stanford University, 750 Welch Rd, Suite 321, Palo Alto, CA, USA.
authors.forename: Stafford
authors.initials: S
authors.lastname: Grady
authors.affiliation: Stanford University, 750 Welch Rd, Suite 321, Palo Alto, CA, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Chi
authors.affiliation: Stanford University, 750 Welch Rd, Suite 321, Palo Alto, CA, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Fernandes
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D059012:Lost to Follow-Up; D008297:Male; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data*; D060305:Transition to Adult Care / Q000592:standards*; D055815:Young Adult
keywords: Adult congenital heart disease; Healthcare transition; Pediatric cardiology