Hospitalization and Readmission among Congenital Heart Disease Patients in Canada

Abstract

The prevalence of congenital heart disease (CHD) is rising, particularly among adults. The rise is particularly prominent for CHD with complex lesions. The impact of these changes on the healthcare system/resource is not known. The first part of this thesis used the hospital discharge abstract data from the Canadian Institute for Health Information and assessed temporal changes in hospitalizations of CHD patients in Canada from 2003 to 2009. Poisson regression analysis was performed to assess temporal changes in the hospitalization rate, stratified by age, sex, and severity of CHD. Increasing inpatient service utilization over time was observed among adult CHD patients particularly in older patients and those with complex CHD. The second part of this thesis focused on determining the readmission rate among CHD patients and identifying risk factors associated with readmission. Poisson regression was used to analyze the readmission rates by age, sex, and severity of CHD. Logistic regression analysis was performed to identify risk factors associated with readmission within two weeks and one month after discharge. The hospital readmission was common among CHD patients particularly among patients aged 40 years or older, males and those with complex CHD. The pattern of inpatient health service utilization by CHD patients in Canada presented in this study would help policy makers to adopt appropriate strategies to meet the increasing demands of this expanding population. In addition, findings on readmission and associated risk factors from our study would facilitate clinicians to identify high-risk patients. We need further studies focusing on the healthcare cost of hospital admissions as well as unplanned readmission among CHD patients.