Open Access

ARTICLE

Analysis of adults with congenital heart disease presenting to pediatric emergency departments with arrhythmias

Shaun Mohan¹, Brady S. Moffett², Wilson Lam², Caridad de la Uz², Christina Miyake², Santiago O. Valdes², Jeffrey J. Kim²

1 Division of Pediatric Cardiology, Department of Pediatrics, Kentucky Children’s Hospital, University of Kentucky, Lexington, Kentucky, USA
2 Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA

* Corresponding Author: Shaun Mohan, 138 Leader Avenue, Lexington, KY 40506-9983. Email:

Congenital Heart Disease 2017, 12(4), 507-511. https://doi.org/10.1111/chd.12478

Abstract

Objective: As survivors of congenital heart disease (CHD) continue to age, healthcare utilization by this population has increased. It is unknown how often these patients utilize the emergency department (ED) at children’s hospitals and how arrhythmias play a role in their utilization of care.
Design: Using a retrospective cohort design, the Pediatric Hospital Information System (PHIS) database was investigated and we studied adults (≥18 years) with CHD (ACHD) who presented to pediatric EDs from 2004 to 2014.
Setting: Tertiary care pediatric hospitals.
Results: Of the 6310 encounters to pediatric EDs, 1594 (25%) were for arrhythmias. The median age was 21 years (IQR 19.1–25.1). The most common tachyarrhythmia diagnoses during the study period were atrial flutter (32%), atrial fibrillation (15%), and paroxysmal VT (10%). Bradyarrhythmias represented a minority of total arrhythmias. Presentation with arrhythmias was associated with an increased risk of admission, ICU care, and death (P< .01). Arrhythmias are also highly associated with CHD severity with twice as many complex CHD having arrhythmias compared to simple CHD (P< .01).
Conclusions: Total admissions of adults with CHD from the ED of children’s hospitals have increased over time while the transfers to outside facilities remain consistently low. While the population of ACHD continues to grow, utilization of pediatric EDs for this cohort has increased. Adults with higher CHD complexity are more likely to present with clinical arrhythmias but there is a growing number of ACHD patients with simple complexity presenting with arrhythmias in recent years. ACHD patients that present with arrhythmias are at increased risk of morbidity and mortality.

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