Mortality and Morbidity Following Heart Failure Hospitalization in Adults With and Without Congenital Heart Disease.

Abstract

To compare the clinical profile and outcomes after heart failure (HF) hospitalization in adults with and without congenital heart disease. Leveraging a national database of commercially insured and Medicare Advantage patients in the United States, this study included patients hospitalized for HF with adult congenital heart disease (ACHD+) and without adult congenital heart disease (ACHD-) between January 1, 2010, and December 31, 2021. The association of baseline characteristics with mortality, major adverse cardiac and cerebrovascular events (MACCE), and health resource utilization was examined using cox proportional hazard regressions. Of 287,616 unique HF admissions, 5805 (2%) were ACHD+ and 281,811 (98%) were ACHD-. Over a mean follow-up period of 1.98±2.04 years, ACHD+ patients had a lower risk of mortality (HR, 0.74; 95% CI, 0.69 to 0.80; P<.001), MACCE (HR, 0.93; 95% CI, 0.89 to 0.97; P=.002), and rehospitalization (HR, 0.91; 95% CI, 0.88 to 0.95; P<.001). One-third (32.6%) of ACHD+ patients experienced a MACCE during follow-up, most commonly due to atrial fibrillation (n=939; 16.1%), recurrent HF (n=696; 12.0%), stroke (n=398; 6.8%) or intracranial bleed (n=102; 1.8%), myocardial infarction (n=276; 4.8%), and cardiac arrest (n=176; 3.0%). Compared with the general HF population, ACHD patients had substantially lower mortality risk after HF hospitalization. Despite this, the risk of complications following HF hospitalization was high, reinforcing the importance of discharge planning and post-acute care for improving outcomes in ACHD HF patients.