Health service utilization patterns among adults with congenital heart disease: A population-based study

Michal Benderly, Jonathan Buber, Ofra Kalter-Leibovici, Leonard Blieden, Alexander Dadashev, Avraham Lorber, Amiram Nir, Sergei Yalonetsky, Gabriel Chodick, Dahlia Weitzman, Ran Balicer, Efrat Mazor Dray, Havi Murad, Yaron Razon, Rafael Hirsch, Michal Benderly, Jonathan Buber, Leonard Blieden, Alexander Dadashev, Avraham LorberAmiram Nir, Efrat Mazor, Yaron Razon

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. METHODS AND RESULTS: We identified 11 653 patients with ACHD aged >18 years (median, 47 years), through electronic re-cords of 2 large Israeli healthcare providers (2007-2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standard-ized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47-1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69-5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82-7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61-16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: Primary care (HR, 1.14; 95% CI, 1.06-1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24-1.59); emergency department visits (HR, 1.19; 95% CI, 1.02-1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49-2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84-0.94]) and periphery (HR, 0.72 [95% CI, 0.58-0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. CONCLUSIONS: Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and eth-nicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.

Original languageEnglish
Article numbere018037
Pages (from-to)1-11
Number of pages11
JournalJournal of the American Heart Association
Issue number2
StatePublished - 19 Jan 2021


FundersFunder number
Israel National Institute for Health Policy Research


    • Adult congenital heart disease
    • Healthcare service utilization
    • Mortality
    • Population-based study


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