Cardiology in the Young

Original Articles

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

Wendy L. Walkera1, Tara Karamloua2, Brian S. Diggsa3, Eric I. Ehielia4, Kirk A. Caddella1, J. S. de la Cruza1 and Karl F. Welkea5 c1

a1 School of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America

a2 Seattle Children's Hospital, Seattle, Washington, United States of America

a3 Department of Surgery, Oregon Health & Science University, Portland, Oregon, United States of America

a4 Jefferson Medical College, Philadelphia, Pennsylvania, United States of America

a5 Mary Bridge Children's Hospital, Multicare Health System, Tacoma, Washington, United States of America

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.

(Received October 04 2010)

(Accepted February 23 2011)

(Online publication June 08 2011)

Correspondence:

c1 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: karl.welke@multicare.org

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