Risk factors for loss to follow-up among children and young adults with congenital heart disease
Risk factors for loss to follow-up among children and young adults with congenital heart disease
复制标题
先天性心脏病儿童和青少年失访的危险因素
作者：
A. Mackie;G. Rempel;K. Rankin;D. Nicholas;J. Magill
摘要目的探讨儿童和青年先天性心脏病患者心脏病失访的危险因素。方法采用配对病例对照设计。2001年1月之前出生的中度或复杂先天性心脏病病例，既往在儿科或成人心脏病诊所随访，但3年或更长时间未就诊。对照组在3年内观察到。对照组与病例按出生年份和先天性心脏病病变以3：1匹配。对病历进行了审查，以确定失访的潜在风险因素。病例和对照组的一个子集参加了电话访谈。结果共74例（66%男性）与222例（61%男性）对照。错过心脏病预约的历史预测失访3年或更长时间（比值比13.0，95%置信区间3.3-51.7）。避免失访的变量是较高的家庭收入（比值比0.87/10，000美元增加，0.77-0.98），5年内的心脏导管插入术（比值比0.2，95%置信区间0.1-0.6），以及需要心脏病学随访的图表记录（比值比0.4，95%置信区间0.2-0.8）。病例缺乏对随访重要性的认识，并将初级保健医生确定为心脏信息的主要来源，而不是心脏病专家。与病例不同的是，对照组有记住约会的方法。结论：有一次或多次心脏病预约缺失的病史可预测失访3年或3年以上，缺乏对随访需求的认识也是如此。较高的家庭收入，最近的导管，和需要后续的医疗记录文件是保护。
Abstract Objective To identify risk factors for loss to cardiology follow-up among children and young adults with congenital heart disease. Methods We used a matched case-control design. Cases were born before January, 2001 with moderate or complex congenital heart disease and were previously followed up in the paediatric or adult cardiology clinic, but not seen for 3 years or longer. Controls had been seen within 3 years. Controls were matched 3:1 to cases by year of birth and congenital heart disease lesion. Medical records were reviewed for potential risk factors for loss to follow-up. A subset of cases and controls participated in recorded telephone interviews. Results A total of 74 cases (66% male) were compared with 222 controls (61% male). A history of missed cardiology appointments was predictive of loss to follow-up for 3 years or longer (odds ratio 13.0, 95% confidence interval 3.3–51.7). Variables protective from loss to follow-up were higher family income (odds ratio 0.87 per $10,000 increase, 0.77–0.98), cardiac catheterisation within 5 years (odds ratio 0.2, 95% confidence interval 0.1–0.6), and chart documentation of the need for cardiology follow-up (odds ratio 0.4, 95% confidence interval 0.2–0.8). Cases lacked awareness of the importance of follow-up and identified primary care physicians as their primary source of information about the heart, rather than cardiologists. Unlike cases, controls had methods to remember appointments. Conclusions A history of one or more missed cardiology appointments predicted loss to follow-up for 3 or more years, as did lack of awareness of the need for follow-up. Higher family income, recent catheterisations, and medical record documentation of the need for follow-up were protective.