Risk factors for loss to follow-up among children and young adults with congenital heart disease Cardiology in the Young, 05/31/2012

Mackie AS et al. – 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.

• Authors 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.

• 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.