Heart 1999;81:57-61 ( January )

Outpatient clinics for adults with congenital heart disease: increasing workload and evolving patterns of referral

M A Gatzoulis, S Hechter, S C Siu, G D Webb

Toronto Congenital Cardiac Centre for Adults, The Toronto Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada

Correspondence to: Dr Webb. email: gwebb{at}torhosp.toronto.on.ca

Accepted for publication 29 July 1998

ObjectiveTo examine the evolving role of specialised outpatient services for adult patients with congenital heart disease.
DesignA retrospective analysis of all patients attending the Toronto Congenital Cardiac Centre for Adults over three corresponding three month periods in 1987, 1992, and 1997.
SettingA tertiary referral centre.
Main outcome measuresPatient demographics, residence, medical and surgical history, type and source of referral, and investigations performed.
ResultsIn all, 570 patients were seen at the clinic during these three periods. There was a 44% and a 269% increase in workload between 1987 to 1992 and 1992 to 1997, respectively. There was a steady fall in mean age of patients seen at the clinic with time (38.5, 33.6, and 31.7 years in 1987, 1992, and 1997, respectively, p < 0.001). New referrals from community cardiologists and family physicians increased more in relative terms than did referrals from the Hospital for Sick Children, Toronto (6.7%, 15%, and 37.5%, p = 0.02). There was a steady increase in patients with previous reparative surgery (48.9%, 59.2%, and 69.2%, p < 0.002). The proportion of patients with previous reoperations also increased (2.3%, 10%, and 9.2%, p < 0.01). Echocardiography remained the predominant method of diagnosis. The diagnostic mix did not change with time.
ConclusionsOver the past 10 years there has been a large increase in adults with congenital heart disease requiring and seeking specialised care in a tertiary health centre, with a concomitant evolution of referral patterns. These data may be helpful in planning of similar paediatric and adult cardiac services for this expanding population.

Keywords: congenital heart disease;  ambulatory clinics

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© 1999 by Heart
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