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. 2025 Aug;4(8):102021.
doi: 10.1016/j.jacadv.2025.102021. Epub 2025 Jul 28.

Impact of Adult Congenital Heart Disease Specialist Visits on Emergent Admissions: Evidence for Guidelines

Anushree Agarwal  1 , Rong Duan  2 , Joseph Bayne  2 , Lindsey Rudov  3 , Rittal Mehta  4 , Ruth Phillippi  4 , Mark Roeder  5 , Sneha Saraf  3 , Ronald Kanter  6 , Jamie L Jackson  7 , Matthew Lewis  8 , Arwa Saidi  9 , Satinder Sandhu  10 , Thomas Young  11 , Roni Jacobsen  12 , Emily Ruckdeschel  13 , Adam Lubert  14 , Harsimran Singh  15 , Ali Zaidi  16 , Dan G Halpern  17 , Scott Leezer  18 , Anitha S John  4 , Thomas Carton  3 ; CHI-RON Investigators
Affiliations

Impact of Adult Congenital Heart Disease Specialist Visits on Emergent Admissions: Evidence for Guidelines

Anushree Agarwal et al. JACC Adv. 2025 Aug.

Abstract

Background: Although routine outpatient visits with adult congenital heart defect (ACHD) specialists have been recommended, the evidence to support this remains sparse.

Objectives: The purpose of this study was to evaluate the association between outpatient ACHD visits and emergent admissions.

Methods: This observational study used standardized electronic health record data from 13 health centers from January 1, 2015 through December 31, 2019. Mixed logistic regression analyses examined the effects of number of outpatient ACHD specialist visits (1-2 considered routine) during a 6-month period on an emergent admission in the subsequent 6-month period, after adjusting for cohort characteristics, CHD severity, and center. Analysis was stratified by ACHD anatomic types and medical conditions associated with or without physiological CHD class.

Results: The 16,142 patients (median age 32 years, 44.9% women, 83.2% White) contributed to 118,079 person-periods, an average of 7.3 periods per person. Between 1.3% and 2.7% of patients had one emergent admission per 6-month period. Patients with zero, 3, 4, or more than 4 prior outpatient visits had 1.34, 1.67, 2.08-, and 2.48 times higher odds of emergent admission, respectively, than those with a prior routine visit (P < 0.05 using the Wald test). The stratified adjusted analysis demonstrated similar J-shaped (nonlinear) relationships by presence of medical conditions but not by anatomic type.

Conclusions: Having routine outpatient ACHD specialist visits over a 6-month period reduces the likelihood of an emergent admission in the subsequent period, findings driven by presence of medical conditions and not anatomic severity. These findings provide supporting evidence for the ACHD guidelines and implementation science research.

Keywords: adult congenital heart disease; emergent admissions; outcomes; outpatient visits.

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Conflict of interest statement

Funding support and author disclosures The study reported in this work was powered by PCORnet, which has been developed with funding from the Patient-Centered Outcomes Research Institute (PCORI). The study was funded through the PCORI Award (RD-2020C2-20347). Dr Agarwal was supported by the grant K23 HL151866 from National Heart, Lung, and Blood Institute (NHLBI) during the conduct of this study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study Population Inclusion/Exclusion criteria for the study cohort were based on the age of the patients, specificity of the ICD codes to identify CHD, mortality or pregnancy status of the patient, and being part of the health system during the study analytic period (2015-2019). Each patient could contribute to multiple 6-month study periods. CHD = congenital heart disease; ICD = International Classification of Diseases.
Figure 2
Figure 2
Outpatient Specialist Visits and Emergent Admission, for All Patients Zero or more than 2 prior outpatient visits, had significantly higher odds of an emergent admission compared to the Ref, the reference category of 1 prior visit. This represents a J-shaped (nonlinear) association between prior outpatient visit and subsequent emergent admission. All analyses were adjusted for health center, age, sex, race, ethnicity, rural residence, neighborhood poverty, CHD severity, medical conditions, and prior inpatient admissions. ACHD = adult congenital heart disease.
Figure 3
Figure 3
Outpatient Specialist Visits and Emergent Admission, Stratified by Anatomic Class Associations between the number of prior outpatient ACHD visits and subsequent emergent admission do not demonstrate the J-shaped (nonlinear) relationships when analyses are stratified by (A) Severe CHD, (B) Moderate CHD, and (C) Simple CHD. All analyses were adjusted for health center, age, sex, race, ethnicity, rural residence, neighborhood poverty, medical conditions, and prior inpatient admissions.
Figure 4
Figure 4
Outpatient Specialist Visits and Emergent Admission, Stratified by Medical Conditions Associations between the number of prior outpatient ACHD visits and subsequent emergent admission demonstrate the J-shaped (nonlinear) relationships when analyses are stratified by (A) Medical conditions likely associated with PhyC B-D, and (B) Medical conditions less likely associated with PhyC B-D. All analyses were adjusted for health center, age, sex, race, ethnicity, rural residence, neighborhood poverty, prior inpatient admissions, CHD severity, and medical conditions (as appropriate). PhyC = physiological Class; other abbreviations as in Figure 2.
Central Illustration
Central Illustration
Impact of Adult Congenital Heart Disease Visits on Emergent Admissions Among 16,142 adults with CHD in care at 13 health centers in the United States, a J-shaped (nonlinear) relationship was observed between the number of outpatient ACHD specialist visits during a 6-month period and an emergent admission during the subsequent period. This demonstrates that routine ACHD specialist visit is associated with reduced emergent admissions; findings driven by the presence of medical conditions and not by anatomic CHD class. Abbreviations as in Figures 1 and 2.
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