title: How often is congenital heart disease recognized as a significant comorbidity among hospitalized adults with congenital heart disease?
abstract: BACKGROUND
  Despite frequent life-long hemodynamic and electrophysiologic abnormalities, adults with congenital heart defects (CHDs) are often lost to medical follow-up. Using a cohort of adults with CHD receiving hospital care in Arkansas, we sought to determine how often a CHD is recognized and coded during hospital admissions.
  
  
  METHODS
  Data for this study come from the Agency for Healthcare Research and Quality's Arkansas State Inpatient Database (SID) for years 2004 to 2012. Using unique identifiers that link patients across hospitalizations, we created a cohort of 3973 patients≥18years old with an ICD-9 code for a CHD diagnosis noted at discharge during any hospitalization.
  
  
  RESULTS
  These 3973 patients had 19,638 hospitalizations. A CHD was listed as the principal diagnosis in 3% of hospitalizations, a secondary diagnosis in 22%, and no CHD was listed in 75% of hospitalizations. Among patients with a critical CHD, no critical CHD was noted in 69% of hospitalizations. Cardiovascular events (heart failure, arrhythmias, cerebrovascular accidents, embolic event, or death) occurred in 60% of hospitalizations of critical CHD patients wherein no critical CHD was recorded.
  
  
  CONCLUSIONS
  CHDs are rarely acknowledged during hospitalizations of adults with a known CHD even when cardiovascular events occur. Improved awareness, disclosure and attention to comorbid CHDs among patients and providers may improve hospital management and outcomes of cardiovascular events.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, United States. Electronic address: RobbinsJamesM@uams.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: Robbins
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Onukwube
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, United States.
authors.forename: Anthony
authors.initials: A
authors.lastname: Goudie
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, United States; Department of Internal Medicine, University of Arkansas for Medical Sciences, United States.
authors.forename: R Thomas
authors.initials: RT
authors.lastname: Collins
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010346:Patient Care Management / Q000458:organization & administration / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration; D014481:United States / Q000453:epidemiology
keywords: Adult congenital heart disease; Cardiovascular events; Death; Hospitalizations; Recognition