Abstract 14744: Driving Distance to a Primary Cardiac Center is Associated With Mortality in Patients With Tetralogy of Fallot Undergoing Neonatal Interventions

Abstract

Introduction: Advances in tetralogy of Fallot care have improved survival, however, associations of sociodemographic disparities and mortality are less well described, particularly among patients with symptomatic tetralogy of Fallot (sTOF) requiring neonatal intervention. Our multicenter Congenital Cardiac Research Collaborative (CCRC) study investigated sociodemographic factors associated with mortality in sTOF patients. Hypothesis: Sociodemographic factors related to a lower socioeconomic status are associated with increased mortality in patients with sTOF. Methods: Retrospective cohort study of neonates with sTOF receiving surgical or catheter-based palliation or primary repair at <30 days old from 1/2005 - 11/2017 at one of nine U.S. centers in the CCRC. Primary outcome variable was mortality at last follow up. Primary predictor variable was childhood opportunity index (COI), a national composite score based on 29 neighborhood-level indicators of poor vs excellent health. Secondary predictor variables included distance to primary cardiac center, race/ethnicity, and maternal insurance type. Sociodemographic factors were evaluated using multivariable Cox proportional hazard models, adjusting for center and patient anatomic and genetic characteristics resulting in hazard ratios (HR) with 95% CI. Results: There were 417 neonates with sTOF, with an overall follow-up mortality of 10% at median follow-up of 4.8 years (25th - 75th %ile: 2.1 - 8.2). Most patients were male (53%), non-Hispanic White (52%), prenatally diagnosed (58%), and had public insurance (54%). On adjusted multivariable analysis, infants >100 miles from a primary heart center had a 3x higher hazard of mortality (HR 2.94; 95% CI, 1.13-7.61; p=0.026) compared to those living <50 miles from a heart center. All other sociodemographic factors (COI, race/ethnicity, and insurance type) were not significantly associated with mortality on multivariable analysis. Conclusions: Proximity to a specialized pediatric cardiac center remains a significant determinant of survival in neonates with sTOF, emphasizing the importance of access to cardiac care. Sociodemographic impact on patient morbidity and lifelong mortality in TOF requires further investigation.