High-volume centers yield better outcomes in congenital cardiac catheterization

In patients with congenital heart disease undergoing cardiac catheterization, major adverse events were highest in centers with the lowest volume, according to new data from the IMPACT registry.

Researchers studied the relationship between volume of cardiac catheterization procedures and major adverse events in patients with congenital heart disease based on data from the IMPACT registry for procedures performed between 2011 and March 2015. They presented their findings at Cardiology 2016, the 19th Annual Update on Pediatric and Congenital Cardiovascular Disease.

The analysis covered 56,453 catheterizations at 77 hospitals. Procedures were stratified by the volume at the center where they were performed: low (less than 150 procedures annually), medium (150 to 299 procedures annually), high (300 to 499 procedures annually) or very high (500 or more procedures annually).

The overall rate of major adverse events was 1.8%.

When the researchers performed an unadjusted analysis, they found that major adverse events occurred in 2.8% of procedures at low-volume centers, 1.5% of procedures at medium-volume centers, 2% of procedures at high-volume centers and 1.5% of procedures at very high-volume centers. Multivariable-adjusted analyses revealed that major adverse events were more likely at low-volume centers. Compared with low-volume centers, odds of an adverse event were less in medium-volume (OR = 0.55; 95% CI, 0.35-0.86), high-volume (OR = 0.62; 95% CI, 0.41-0.95) and very high-volume (OR = 0.52; 95% CI, 0.31-0.9) centers.

“Although the risk [for major adverse events] after cardiac catheterization in patients with [congenital heart disease] is low at all hospitals, it is higher among hospitals with fewer than 150 cases annually,” Natalie M. Jayaram, MD, pediatric cardiologist at Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, and colleagues wrote in an abstract. “These results support the notion that performing congenital cardiac catheterization procedures at higher-volume centers may be associated with improved patient outcomes.”

Natalie M. Jayaram

Jayaram told Cardiology Today that “because of the small absolute differences in rates of major adverse events based upon center volume, it would be difficult to make definitive recommendations regarding regionalization of care based upon our study results alone. Rather, our study results should be considered alongside patient preferences and issues regarding access to care.” – by Erik Swain

Reference:

Jayaram NM, et al. Abstract 41. Presented at: Cardiology 2016, the 19th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 24-28, 2016; Orlando, Fla.

Disclosure: Jayaram reports no relevant financial disclosures.