Trends in Patient Characteristic, Cost, and Mortality Among Mechanically Ventilated Adult Patients With Congenital Heart Disease in the United States
Bibliographic record
Abstract
BackgroundThere is an increasing number of adults with congenital heart disease (ACHD), but critically ill patients with ACHD remain understudied. The objective of this study was to evaluate patient characteristics and trends in mortality of mechanically ventilated patients with ACHD.MethodsWe evaluated ACHD with an ICD-9 procedure code for mechanical ventilation using the National Inpatient Sample (NIS), a public all-payer inpatient United States database, from 2005 to 2014. Primary and secondary outcomes were evaluated using multivariable logistic regression.ResultsThere were 10,962 of 77,334,704 discharges, representing 52,876 (0.6%) hospitalizations that were for patients with ACHD who required mechanical ventilation (MV). Mean age was 59 years (interquartile range: 45-71); 45.3% were female patients. The number of patients with ACHD requiring MV increased over the years (2342 to 7775, P < 0.001). Age and comorbidities of this cohort also increased (55 to 59, P < 0.001; 1 to 2, P < 0.001). Case-fatality ratio remained stable over the years (0.254 to 0.259, P = 0.42). Median cost of hospital stay was USD $49,583 and remained stable over the study period (P = 0.42), whereas total cost increased from $115 million to $564 million (P < 0.001).ConclusionsThe number of mechanically ventilated ACHD has increased over the years. Remarkably, despite an increase in the age and comorbidity burden in this cohort, case-fatality ratio of these patients and the cost per patient remained stable. Nonetheless, there is a growing need for health care resources in the management of this cohort of patients. Further studies will need to be conducted to evaluate the underlying physiological impact and prognosis of MV in specific subsets of ACHD.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".