Aging in America News

| New Findings Pertaining to Older Adults Living with Congenital Heart Disease

| Karen Fischer

| Heart disease is the leading cause of death for Americans, and with a rapidly aging population, access to cardiac care is becoming ever more critical. In 2024 about one in five Americans were covered by Medicare, and of them, 20% live in what’s classified as rural areas. That’s precisely why numerous early-career researchers focused on the impact of distance as a health deterrent this year at the American Heart Association Scientific Sessions in New Orleans. 

Though their findings are applicable to older people living with numerous health conditions, their research focus was on the medical infrastructure available out there for people living with congenital heart disease (CHD). 

CHD arises in approximately 1% of all U.S. births. The condition can be classified as cardiac complications such as holes in the heart, too few blood vessels, or issues with heart valves that control blood flow, among others. 

Historically, CHD was deadly for children, but a slew of medical innovations and interventions over the past few decades have helped more young patients live long, healthy lives into adulthood. Even so, that means that older adults with CHD still need access to specialized medical care that existing medical infrastructure isn’t entirely equipped to handle. For example, some of this population had numerous surgeries in their infancy, and now that they’re living into adulthood, specialists are discovering complications down the road, so patients should have access to adult CHD-accredited centers throughout their lives.

For example, Claire Cambron, a general cardiology fellow in Portland, investigated how an urban or rural residence impacted health outcomes for adults between the ages of 18-65 living with CHD. She drew from a nationwide database that collects public health data from all 50 states, identifying just over 300,000 adult CHD patients and zeroing in on who had rural area codes and Medicaid coverage. Over half of those patients were women, and a little over a quarter had moderate to severe CHD. 

“Among those with more complex disease, a greater proportion lived in a more rural residence,” she says. “We found that rural residences were associated with lower income, a higher burden of disability, higher rates of morbidity, and higher age-adjusted rates of death.”

“We found that rural residences were associated with lower income, a higher burden of disability, higher rates of morbidity, and higher age-adjusted rates of death.”

The findings point to the need for enhanced CHD infrastructure to help reach these impacted communities throughout the course of their life as they relocate into more rural pockets of the country. There is also the question of providers who choose to congregate in major cities instead of relocating to more off the beaten path locales.

Another researcher found cause for optimism through the lens of pediatric CHD patients.

Avery Lewis, a medical student at the University of Toledo in Ohio, analyzed how living in a rural or urban area impacted kids with CHD, and their overall health outcomes. The team identified pediatric CHD patients in the Nationwide Children’s hospital network from 2013 and 2023, and determined whether their address was considered urban or rural. In total, 13,000 patients were identified, and 28% were from rural pockets of the state. 

Lewis hypothesized that rural patients would have more emergency room visits, fewer outpatient follow-ups, and more in-patient hospitalizations, but that hypothesis was incorrect. Rural pediatric patients actually had higher rates of outpatient cardiology visits, and fewer emergency room visits. 

“One of the things we were thinking is that Nationwide Children’s has a lot of satellite clinics in rural areas,” she says. “Those weren’t necessarily classified.”

Satellite clinics are small health centers that are associated with a larger system that is usually in a major city, but have a physical presence in rural areas throughout a larger region. This analysis found that in the case of pediatric CHD in Ohio, these satellite support systems were doing their job, and contributing to positive health outcomes for patients and generally improving the negative impacts of rurality in the social determinants of health. With impending Medicaid cuts, these community assets are now facing existential threats.

“We just looked at pediatric populations, but I think this could be translated to adults as well,” Lewis says. “This could be the same for older adults who don’t have reliable transportation in rural areas that just have a hard time getting to these larger centers where they need more complex care. It’s just not as accessible.”

Karen Fischer is an independent writer and reporter. Her work has appeared in such publications as CQ Researcher, Prism Reports, Eater, The Verge, and Business Insider, among others. She also produces The Gumbo Pot, a weekly Substack featuring independent reportage on education, health, culture, food, infrastructure, and energy.