Cardiology and the broader medical community lost no time in denouncing last June's US Supreme Court ruling that overturned the 1973 Roe v. Wade decision establishing abortion rights, or in detailing its threats to medical ethics and women's health and safety.
Now they should lose no time confronting another threat from the ruling that looms over the clinical workforce, policymakers, third-party payers, and young patients of all kinds, urges a commentary released this week.
"The overturning of Roe v. Wade will increase births, and this will include children with birth defects, such as congenital cardiac disease," it states. "The strain on the health care system needs to be assessed and planned for."
The report estimates a "best-case scenario" of 539 additional infant cardiac surgeries in the United States the first year after implementation of new restrictions on abortion in the wake the tumultuous Dobbs v. Jackson Women’s Health Organization decision.
Their surgeries likely wouldn't stop with the first, so those 539 cases would account for an estimated 7243 further congenital cardiac procedures over the next decade "after including the additional volume from patients aged 1 to 17 years," notes the commentary, published February 13 in the Journal of the American College of Cardiology. Its lead author is Ashwin Palaniappan, a student at the Warren Alpert Medical School of Brown University, Providence, Rhode Island.
The added annual cases would equal "the size of a pretty substantial congenital heart program," senior author Brett R. Anderson, MD, MBA, told theheart.org | Medscape Cardiology.
Could the field at current staffing levels and resources for pediatric cardiac surgery handle that many added cases? Possibly, if they were spread across the United States, proposed Anderson, a pediatric cardiologist and outcomes researcher at Columbia University Irving Medical Center, New York City.
But they are not spread across the country. The burden will belong to the 20 or more states that have restricted or plan to restrict abortion access. Hospitals in those states, Anderson said, "as they plan out for the next 10 years, need to anticipate that the volume of pediatric procedures is going to go up." Their health systems and providers "should start planning for these additional lives and how they are going to step up manpower for them."
Preparations are also needed at the state and national levels to address the added financial burden, the report states. "The average inpatient costs alone of managing a patient with congenital heart disease surgically in their first year of life is approximately $127,000, and $58,000 for each year from ages 1 to 17," adjusted for inflation. With further procedures as each child grows older, the total added inpatient bill over a decade, they write, could reach $820 million.
"What are the implications for insurance companies, and for Medicaid?" Anderson posed. "And how are they going to ensure that kids get access to all kinds of care, not just cardiac care?"
Indeed, ripple effects from the added cases could "extend beyond the new babies with congenital cardiac defects to other children who are unable to receive timely intervention," the article notes.
For example, children with congenital heart disease "use a lot of health care resources," Anderson said. They see not only pediatric cardiologists and cardiac surgeons, but likely will need special care from gastroenterologists, pulmonologists, and a range of other specialists.
That means "wait times for the average child who needs to see their pulmonologist for asthma are going to go up," she noted. "There just is not going to be the room in the medical community to absorb these extra healthcare lives."
Analysis of the "full scope of the impact" of last year's high court decision is needed to prepare for and mitigate "the consequences of limited access to abortion," the report states, "so that we can be better prepared to care for our patients and be better equipped to advocate on their behalf in the future."
The authors report no relevant financial relationships.
J Am Coll Cardiol, 2023. Published online February 13. Full Text
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Cite this: Congenital Heart Disease Care Braces for Effects of Roe v. Wade - Medscape - Feb 15, 2023.