Intensive care in adults with congenital heart disease: cost implications of a changing patient population

Introduction

Current estimations suggest there are around 800,000 patients in the USA with congenital cardiac lesions requiring specialist care [1]. Improved surgical and cardiological interventions mean that numbers of patients with moderate-severe congenital lesions will increase [2], resulting in increased requirement for repeat surgery in adulthood. This is reflected by an increasingly complex case mix requiring ICU admission. The potential impact of this changing patient population upon ICU resources has not been addressed.

Methods

A database (Medicus, High Wycombe, UK) was interrogated for all patients admitted to the ICU during the period January 1997–2002 with adult congenital heart disease (ACHD), which was classified as simple or complex according to the modified Canadian Consensus Conference criteria. Patient demographics, the length of ICU stay (LOS) and mortality were extracted, and the severity of illness and intensity of intervention calculated (APACHE II, TISS-28).

Results

Of 5312 patients admitted during the accounting period, 342 had ACHD (6.4%). ACHD ICU mortality was 4.4%. Patients with simple ACHD (32%) had APACHE II scores of 18.4 ± 4.8, zero mortality, short LOS (1.8 ± 2 days), and low therapeutic intervention (TISS-28 42.3 ± 10). Patients with complex ACHD (68%) had similar APACHE II scores (18.5 ± 6.4, not significant) but significantly higher mortality (10.6%), increased LOS (3.9 ± 2 days, P < 0.05) and requirement for intervention (TISS-28 59.8 ± 13, P < 0.05). Overall mean cost per admission (TISS score point 46.31, €67.0) was therefore significantly higher in the more complex patients (simple €5101 ± 1340 vs complex € 15,623 ± 1742, P < 0.05).

Conclusion

Improved survival of patients with complex congenital heart disease to adulthood will have significant implications (clinical and financial) in any ICU undertaking this work.