The effect of area deprivation on missed cardiology appointments and subsequent acute hospital visits.

Abstract

Introduction: Children with CHD require long-term follow-up, but missed visits among patients are common. Missed appointments likely contribute to excess morbidity and mortality. Our study seeks to identify social factors that could predict patients at risk of missing cardiology visits and to determine if missed visits and these social factors contribute to increased emergency department utilisation.

Materials and methods: We conducted a single-centre chart review of CHD patients seen from 2012-2024 and analysed trends in paediatric cardiology clinic attendance, particularly the number of missed appointments. We also looked at emergency department visits and subsequent admissions among these groups. The primary exposure was the area deprivation index, a composite measure of neighbourhood disadvantage based on income, education, employment, and housing quality. We also compared the number of acute visits between patients with more missed visits.

Results: We included 1,060 patients with CHD, and 46% of our population had ≥2 missed clinic visits, 31% had ≥5 emergency department visits, and 32% had ≥2 admissions. The number of missed visits increased across area deprivation index quartiles, though the number of emergency department visits and admissions was not significantly affected by area deprivation index. Patients with more missed visits were more likely to have more emergency department visits and admissions.

Discussion: Our data suggest a relationship between community deprivation and missed clinic visits, and missed clinic visits seem to confer a greater risk of emergency department visits and unplanned admissions. Area deprivation index is a parameter available in major electronic health records and could be used to identify patients at risk for missed visits.