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Comorbidity, health care utilisation and process of care measures in patients with congenital heart disease in the UK: cross-sectional population-based study with case control analysis
  1. Julie Billett (juliebillett{at}yahoo.co.uk)
  1. Imperial College London, United Kingdom
    1. Martin R Cowie (m.cowie{at}imperial.ac.uk)
    1. National Heart & Lung Institute, United Kingdom
      1. Michael Gatzoulis (m.gatzoulis{at}rbht.nhs.uk)
      1. RBH, United Kingdom
        1. Isabelle Van Der Muhll (isabelle.vondermuhll{at}capitalhealth.ca)
        1. University of Alberta, Canada
          1. Azeem Majeed (a.majeed{at}imperial.ac.uk)
          1. Imperial College London, United Kingdom

            Abstract

            Background Relatively little is known about the prevalence of comorbidities, patterns of health care utilisation and primary care recording of clinical indicators in patients with congenital heart disease.

            Methods We conducted a population-based case control study using data from general practices across the UK contributing data to the QRESEARCH primary care database. The subjects were 9952 cases of congenital heart disease and 29837 matched controls. Outcome measures were: Prevalence (%) of selected comorbidities; adjusted odds ratios (OR) for risk of comorbidities, health care utilisation and clinical indicator recording.

            Results The overall crude prevalence of congenital heart disease was 3.05 per 1000 patients (95% CI 2.90 to 3.11). Prevalence of key comorbidities in congenital heart disease patients ranged from 2.4% (95% CI 2.1 to 2.7) for epilepsy to 9.3% (95% CI 8.8 to 9.9) for hypertension. After adjusting for smoking and deprivation, cases were significantly more likely than controls to have each of the cardiovascular comorbidities e.g. adjusted odds ratio for atrial fibrillation 7.6 (6.1 to 9.3), and also had an increased risk of diabetes, epilepsy and renal disease. Patients with congenital heart disease were heavier users of primary care than controls. congenital heart disease patients were also more likely than controls to have lifestyle and risk factor measurements recorded in primary care e.g. adjusted odds ratio for BMI recording in cases versus controls 1.23 (95% CI 1.16 to 1.31), although overall levels of recording were low.

            Conclusions There is a significant burden of comorbidity associated with congenital heart disease, and levels of primary care utilisation and referral to secondary care are high in this patient population. The predicted future expansion in the numbers of adults with congenital heart disease owing to improvements in survival will have implications for primary and secondary care, and not just tertiary centres offering specialist care.

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