title: Compliance with Adult Congenital Heart Disease Guidelines: Are We Following the Recommendations?
abstract: OBJECTIVE
  As the adult congenital heart disease population increases, poor transition from pediatric to adult care can lead to suboptimal quality of care and an increase in individual and institutional costs. In 2008, the American College of Cardiology and American Heart Association updated the adult congenital heart disease practice guidelines and in 2011, the American Heart Association recommended transition guidelines to standardize and encourage appropriate timing of transition to adult cardiac services. The objective of this study was to evaluate if patient age or complexity of congenital heart disease influences pediatric cardiologists' decision to transfer care to adult providers and to evaluate the compliance of different types of cardiology providers with current adult congenital heart disease treatment guidelines.
  
  
  METHODS
  A single-center retrospective review of 991 adult congenital heart disease patients identified by ICD-9 code from 2010 to 2012.
  
  
  METHODS
  Academic and community outpatient cardiology clinics.
  
  
  METHODS
  Nine hundred ninety-one patients who are 18 years and older with congenital heart disease.
  
  
  METHODS
  None.
  
  
  METHODS
  The compliance with health maintenance and transfer of care recommendations in the outpatient setting.
  
  
  RESULTS
  For patients seen by pediatric cardiologists, only 20% had transfer of care discussions documented, most often in younger simple patients. Significant differences in compliance with preventative health guidelines were found between cardiology provider types.
  
  
  CONCLUSIONS
  Even though a significant number of adults with congenital heart disease are lost to appropriate follow-up in their third and fourth decades of life, pediatric cardiologists discussed transfer of care with moderate and complex congenital heart disease patients less frequently. Appropriate transfer of adults with congenital heart disease to an adult congenital cardiologist provides an opportunity to reinforce the importance of regular follow-up in adulthood and may improve outcomes as adult congenital cardiologists followed the adult congenital heart disease guidelines more consistently than pediatric or adult cardiologists.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minn, USA.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Gerardin
authors.affiliation: Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minn, USA.
authors.forename: Jeremiah S
authors.initials: JS
authors.lastname: Menk
authors.affiliation: Department of Pediatrics, Section of Pediatric Cardiology, West Virginia University, Morgantown, WVa, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Pyles
authors.affiliation: Department of Medicine, Division of Cardiology Section of Adult Congenital and Cardiovascular Genetics, University of Minnesota, Minneapolis, Minn, USA.
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Martin
authors.affiliation: Division of Pediatric Cardiology and Section of Adult Congenital and Cardiovascular Genetics, Department of Pediatrics, University of Minnesota, Minneapolis, Minn, USA.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Lohr
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000592:standards*; D003266:Continuity of Patient Care / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D008910:Minnesota; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D017064:Process Assessment, Health Care / Q000592:standards*; D012189:Retrospective Studies; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adult Congenital Heart Disease; Pediatric Cardiology; Preventive Care; Transfer of Care; Transition