title: Trends in the Burden of Adult Congenital Heart Disease in US Emergency Departments.
abstract: BACKGROUND
  We assessed trends in incidence, in-hospital mortality, and admission among patients with adult congenital heart disease (ACHD) presenting to the emergency department (ED) from 2006 to 2012.
  
  
  OBJECTIVE
  There is a considerable burden of ACHD in the US EDs.
  
  
  METHODS
  We used the 2006-2012 US Nationwide Emergency Department Sample. All ED visits with ACHD were identified using standard International Classification of Diseases, Ninth Edition, Clinical Modification codes.
  
  
  RESULTS
  The number of patients presenting to the ED with simple (40.6%) as well as complex (37.6%) ACHD across 2006-2012 increased significantly. Also, there was a considerable increase in prevalence of traditional cardiovascular risk factors among ACHD patients, including hypertension, diabetes, smoking, obesity, and chronic kidney disease. Besides miscellaneous noncardiovascular conditions, nonspecific chest pain (15.9%) and respiratory disorders (15.0%) were the most common reasons for ED visits among patients with simple and complex ACHD, respectively. Although there was a trend toward decrease in admissions across 2006-2012 (Ptrend  < 0.001), the proportion of patients with ACHD presenting to ED requiring admission remained substantial (63.4%). Finally, there was significant variation in admission trends across different geographic locations, hospital types, insurance status, and ED volume among ACHD patients presenting to the ED.
  
  
  CONCLUSIONS
  There has been a progressive increase in number of ED visits among ACHD patients across 2006-2012 in the United States. Moreover, the cardiovascular risk-factor profile of ACHD patients has changed, adding to complexity in management. Current health care delivery to ACHD patients also shows significant geographical, hospital-based, and insurance status-based disparities.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Ohio.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Ohio.
authors.forename: Karan
authors.initials: K
authors.lastname: Sud
authors.affiliation: Department of Cardiovascular Medicine, New York Medical College, Valhalla, New York.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.affiliation: Department of Cardiovascular Medicine, Brown University, Providence, Rhode Island.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.affiliation: Department of Cardiovascular Medicine, University of California, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Department of Cardiovascular Medicine, New York Medical College, Valhalla, New York.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Panza
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Ohio.
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
mesh_terms: D000328:Adult; D017281:Cost of Illness; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006330:Heart Defects, Congenital / Q000191:economics* / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology