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Heart 1999;81:57-61 ( January )
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
Objective
To 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.
This article has been cited by other articles:
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