| アブストラクト | BACKGROUND: The emerging burden and need of hospital admission due to adult congenital heart disease (ACHD) will need many facilities with expertise in ACHD. Regional specialized ACHD centers are carrying this increasing patient burden. Although these centers are considered to perform better management than other institutes, their impact on outcome has not been fully evaluated. METHODS: We used the Japanese Registry of All cardiac and vascular Diseases (JROAD) and the JROAD Diagnosis Procedure Combination (DPC)/Per Diem Payment System dataset and certification data. We only analyzed adult (>/=15 years old) patients with ACHD, defined by the International Classification of Diseases, Tenth Revision, diagnosis codes, between April 1, 2013, and March 31, 2014. We defined a "minimal essential regional ACHD (MER-ACHD) center" as an education institute accredited by adult and pediatric cardiology societies. The primary outcome is 30-day mortality. We investigated the impact of MER-ACHD centers on 30-day mortality by using generalized estimating equations. RESULTS: Of the 538 hospitals registered at JROAD that agreed to participate in the DPC discharge database study, 65 (12.1%) were MER-ACHD centers. Of 4818 patients (46.8% male; age, 50.1+/-21.4 years), 45.5% were admitted to a MER-ACHD center. Nearly half (48.1%) of the admissions were cases of atrial septal defect, followed by ventricular septal defect, tetralogy of Fallot, and congenital insufficiency of the aortic valve or bicuspid aortic valve. Multivariate analysis revealed a negative impact of emergency admission [1.051 (1.042-1.061)] and a positive impact of MER-ACHD centers [0.986 (0.973-0.999)] on 30-day mortality after adjustment of disease severity. CONCLUSION: We noted the impact of MER-ACHD centers on 30-day mortality. Further investigation is needed to establish appropriate regional ACHD center criteria to deliver appropriate ACHD management. |
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| ジャーナル名 | Journal of cardiology |
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| 投稿日 | 2019/8/20 |
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| 投稿者 | Mizuno, Atsushi; Niwa, Koichiro; Ochiai, Ryota; Shiraishi, Isao; Sumita, Yoko; Daida, Hiroyuki; Fukuda, Terunobu; Miyamoto, Yoshihiro; Nishimura, Kunihiro; Ogawa, Hisao; Yasuda, Satoshi |
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| 組織名 | Department of Cardiology, Juntendo University Hospital, Tokyo, Japan; Department;of Cardiology, St. Luke's International Hospital, Tokyo, Japan. Electronic;address: atmizu@gmail.com.;Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.;School of Medicine Nursing Course, Yokohama City University, Yokohama, Japan.;Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center,;Osaka, Japan.;Center for Cerebral and Cardiovascular Disease Information, National Cerebral and;Cardiovascular Center, Suita, Osaka, Japan.;Department of Cardiology, Juntendo University Hospital, Tokyo, Japan.;Department of Statistics and Data Analysis Center for Cerebral and Cardiovascular;Disease Information, National Cerebral and Cardiovascular Center, Suita, Japan.;Department of Cardiovascular Medicine, National Cerebral and Cardiovascular;Center, Suita, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/31421934/ |
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