Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-08T00:17:16.006Z Has data issue: false hasContentIssue false
  • English
  • Français

Geography or pathology? Regional variation in atrial septal defect closure rates and techniques

Published online by Cambridge University Press:  08 June 2011

Wendy L. Walker ,
Tara Karamlou ,
Brian S. Diggs ,
Eric I. Ehieli ,
Kirk A. Caddell ,
J. S. de la Cruz  and
Karl F. Welke
Wendy L. Walker
Affiliation:
School of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
Tara Karamlou
Affiliation:
Seattle Children's Hospital, Seattle, Washington, United States of America
Brian S. Diggs
Affiliation:
Department of Surgery, Oregon Health & Science University, Portland, Oregon, United States of America
Eric I. Ehieli
Affiliation:
Jefferson Medical College, Philadelphia, Pennsylvania, United States of America
Kirk A. Caddell
Affiliation:
School of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
J. S. de la Cruz
Affiliation:
School of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
Karl F. Welke*
Affiliation:
Mary Bridge Children's Hospital, Multicare Health System, Tacoma, Washington, United States of America
*
Correspondence to: Dr K. F. Welke, MD, MS, Mary Bridge Children's Hospital, Multicare Health System, PO Box 5229, Tacoma, Washington 94815 0229, United States of America. Tel: 253 403 3527; Fax: 253 403 3285; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Since the introduction of percutaneous closure in the United States, rates of secundum atrial septal defect and patent foramen ovale closures have increased substantially. Whether or not closure rates are uniform or vary due to differences in regional practice patterns is unknown. We sought to investigate this by comparing regional rates of closure across Florida.

Methods

We identified all atrial septal defect closures from 2001 to 2006 in the Florida State Inpatient Database. Using small area analysis, zip codes were assigned to Hospital Referral Regions based on where patients were most likely to go for closure. We obtained population-normalised rates of overall, percutaneous, and surgical closure.

Results

Of 1830 atrial septal defect and patent foramen ovale closures from 2001 to 2006, 751 were surgical and 1004 were percutaneous. The statewide closure rate was 1.91 per 100,000 people per year; regional rates varied 3.8-fold from 0.78 to 2.94 per 100,000 people per year. Percutaneous rates varied sevenfold from 0.25 to 1.75 per 100,000 people per year, while surgical rates varied 2.71-fold from 0.53 to 1.44 per 100,000 people per year.

Conclusions

Despite a consistent prevalence of atrial septal defects, and patent foramens ovale, rates of repair vary across regions, suggesting that closure is driven by provider practice patterns rather than patient pathology. Efforts should be directed towards increasing consensus regarding the appropriate, evidence-based indications for closure so as to avoid the costs and potential negative sequelae of over- or undertreatment.

Keywords

Congenital heart diseaseseptal defectpercutaneoussurgery
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 5 , 09 September 2011 , pp. 577 - 584
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hagen, PT, Scholz, DG, Edwards, WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984; 59 1: 17–20.CrossRefGoogle ScholarPubMed
2.Carlgren, LE. The incidence of congenital heart disease in children born in Gothenburg 1941–1950. Br Heart J 1959; 21: 40–50.CrossRefGoogle ScholarPubMed
3.Hailey, D, Topfer, LA. Transcatheter closure of atrial septal defects. Issues Emerg Health Technol 2003; 47: 1–6.Google Scholar
4.Karamlou, T, Diggs, BS, Ungerleider, RM, McCrindle, BW, Welke, KF. The rush to atrial septal defect closure: is the introduction of percutaneous closure driving utilization? Ann Thorac Surg 2008; 86: 1584–1591.CrossRefGoogle ScholarPubMed
5.Wennberg, J, Gittelsohn, A. Small area variations in health care delivery. Science 1973; 182: 1102–1108.CrossRefGoogle ScholarPubMed
6. The Dartmouth Institute for Health Policy and Clinical Practice. The Dartmouth Atlas of Health Care. http://www.dartmouthatlas.org (accessed 5 May 2011).Google Scholar
7.O'Connor, GT, Quinton, HB, Traven, ND, et al. Geographic variation in the treatment of acute myocardial infarction: the Cooperative Cardiovascular Project. JAMA 1999; 281: 627–633.CrossRefGoogle ScholarPubMed
8.Lucas, FL, Wennberg, DE, Malenka, DJ. Variation in the use of echocardiography. Eff Clin Pract 1999; 2: 71–75.Google ScholarPubMed
9.Gittelsohn, A, Powe, N. Small area variation in health care delivery in Maryland. Health Serv Res 1995; 30: 295–317.Google ScholarPubMed
10.Ashton, CM, Petersen, NJ, Souchek, J, et al. Geographic variations in utilization rates in veterans affairs hospitals and clinics. N Engl J Med 1999; 340: 32–39.CrossRefGoogle ScholarPubMed
11.Feasby, TE, Hude, Q, Ghalie, WA. Geographic variation in the rate of carotid endarterectomy in Canada. Stroke 2001; 32: 2417–2422.CrossRefGoogle ScholarPubMed
12.Beller, GA. President's page: geographic variations in delivery of cardiovascular care: an issue of great importance to cardiovascular specialists. J Am Coll Cardiol 2000; 36: 652–655.CrossRefGoogle ScholarPubMed
13.Peterson, MG, Hollenberg, JP, Szatrowski, TP, Johanson, NA, Mancuso, CA, Charlson, ME. Geographic variations in the rates of elective total hip and knee arthroplasties among Medicare beneficiaries in the United States. J Bone Joint Surg Am 1992; 74: 1530–1539.CrossRefGoogle ScholarPubMed
14.Berger, F, Vogel, M, Alexi-Meskishvili, V, Lange, PE. Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg 1999; 118: 674–678.CrossRefGoogle ScholarPubMed
15.HCUP State Inpatient Databases (SID). Healthcare Cost and Utilization Project (HCUP) 2001–2006. Agency for Healthcare Research and Quality, Rockville, MD, 2006.Google Scholar
16. US Census Bureau. Census 2000 Zone Improvement Plan Code Tabulation file. http://www.census.gov/tiger/tms/gazetteer/zcta5.txt (accessed 1 October 2008).Google Scholar
17. US Census Bureau. County Population Estimates file. http://www.census.gov/popest/counties/asrh/files/cc-est2007-alldata-12.csv (accessed 31 October 2008).Google Scholar
18. US Census Bureau. Census 2000 5-digit Zone Improvement Plan Code Cartographic Boundary file. http://www.census.gov/geo/www/cob/z52000.html (accessed 28 January 2009).Google Scholar
19.R Development Core Team (2009). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria.Google Scholar
20.Warnes, CA, Williams, RG, Bashore, TM, et al. AHA/ACC guidelines for the management of adults with congenital heart disease. Circulation 2008; 118: e744–e749.Google Scholar
21.Birkmeyer, JD, Sharp, SM, Finlayson, SR, Fisher, ES, Wennberg, JE. Variation profiles of common surgical procedures. Surgery 1998; 124: 917–923.CrossRefGoogle ScholarPubMed
22.Wennberg, JE, Freeman, JL, Culp, WJ. Are hospital services rationed in New Haven or over-utilised in Boston? Lancet 1987; 1: 1185–1189.CrossRefGoogle ScholarPubMed
23.Romano, PS, Zach, A, Luft, HS, Rainwater, J, Renny, LL, Campa, D. The California hospital outcome project: using administrative data to compare hospital performace. Jt Comm J Qual Improv 1995; 21: 668–682.Google Scholar
24.Demlo, LK, Campbell, PM. Improving hospital discharge data: lesson from the National Hospital Discharge Survery. Med Care 1981; 19: 1030–1040.CrossRefGoogle Scholar
25.Welke, KF, Karamlou, T, Diggs, BS. Comparison of administrative and clinical data for assessment of patients with congenital heart disease. Cardiol Young 2008; 18 Suppl 2: 137–144.CrossRefGoogle Scholar
26.Grubesic, TH, Matisziw, TC. On the use of ZIP codes and ZIP code tabulation areas (ZCTAs) for the spatial analysis of epidemiological data. Int J Health Geogr 2006; 5: 58–72.CrossRefGoogle ScholarPubMed