Adults with congenital heart disease who are hospitalized for heart failure (HF) have nearly 2-fold higher adjusted odds of a longer length of stay (LOS) and in-hospital mortality than adults without congenital heart disease, according to a study published in the Journal of the American Heart Association.
Researchers accessed the Health Care Utilization Project California State Inpatient Database to retrospectively examine all discharges between January 1, 2005, and January 1, 2012, with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for HF (N=203,759). Patients were categorized as having congenital heart disease if their discharge abstract included any ICD-9 codes for congenital heart disease (n=539), and congenital heart disease was further categorized into complex (n=82) or noncomplex (n=457). Patients with both complex and noncomplex diagnoses were assigned to the complex congenital heart disease group. The primary outcome was any adverse event (AE), which included any in-hospital AE during the index admission or readmission within 30 days.
Patients with congenital heart disease had a significantly higher incidence of any AE compared with patients who did not have congenital heart disease (40.5% vs 29.0%; P <.001). They also had higher rates of any in-hospital event, LOS ≥7 days, and incident arrhythmia. Median LOS was significantly longer among patients with congenital heart disease than patients without congenital heart disease (4 days, interquartile range [IQR] 2.7 vs 3 days, IQR 2.6; P =.0001). After adjusting for covariates, the odds of an AE remained significantly higher for patients with congenital heart disease compared with patients without congenital heart disease (adjusted odds ratio 2.1; 95% confidence interval [CI], 1.7–2.5; P <.001). There was no significant difference in rates of readmission between patients with or without congenital heart disease.
Limitations of this study include possibly incorrect congenital heart disease coding in the hospital discharge abstract database. For this reason, the researchers excluded patients with atrial septal defect because coding for this and patent foramen ovale are frequently incorrect. Details regarding clinical presentation, medication use, and similar characteristics during hospitalization could not be studied. Due to reliance on the database, the researchers were unable to capture out-of-hospital events or mortality, or quality of care before or after hospitalization.
The researchers suggested that there are higher odds of incident arrhythmias and mortality among patients with congenital heart disease hospitalized for HF. This also suggests a need to develop tools for risk prediction that might guide clinicians in making appropriate management decisions. Targeted prevention and treatment protocols for HF in this population need to be developed to reduce the burden of adverse clinical outcomes during admission.
Agarwal A, Dudley CW, Nah G, Hayward R, Tseng ZH. Clinical outcomes during admissions for heart failure among adults with congenital heart disease [published online August 17, 2019]. J Am Heart Assoc. doi:10.1161/JAHA.119.012595