Impact of Distance from a Congenital Heart Program on Mortality Outcomes for Patients Under 25 with Congenital Heart Disease in Michigan.
Nathaniel Reed1, Zachary Brennan2, John Treffalls3, Sarin Paluri4.
1DMC Sinai Grace, Detroit, MI, USA, 2Michigan State University, Royal Oak, MI, USA, 3University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA, 4Midwestern University, Chicago, IL, USA.
OBJECTIVE: Regionalization of congenital heart surgery has been proposed to improve outcomes for patients with congenital heart disease (CHD). We aimed to assess the effect of distance from a congenital heart center on all-cause mortality for patients with CHD.
METHODS: The Michigan Birth Defects Registry from 2000-2021 and U.S. census data were used to assess zip code distance to each congenital heart center in Michigan; all patients with pediatric heart disease under 25 were included. A negative binomial mixed regression was run to predict the number of deaths due to heart disease per year based on distance and volume of the nearest pediatric heart center.
RESULTS: There are three pediatric heart centers in Michigan with an average volume of 1106.9 annual cases. The average zip code distance to the nearest center was 119 miles. The number of deaths due to heart disease was lower in counties that are greater distances from pediatric heart centers (Incidence Rate Ratio, IRR=0.997, (95% CI 0.996-0.999, p<.001). The number of deaths due to heart disease was higher in counties in which the nearest pediatric heart center has a higher volume (IRR=1.032, 95% CI 1.006-1.058, p=.015)
CONCLUSIONS: Though statistically significant, there does not seem to be a clinically significant relationship between death due to pediatric heart disease and distance to a congenital heart center. Regionalization of congenital heart centers may be useful to lower mortality due to heart defects in children.
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