HF hospitalization in adult congenital heart disease confers 4-year elevated death risk
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Among adults with congenital heart disease hospitalized for HF, mortality risk remained high for up to 4 years after hospital discharge, according to a study published in Circulation: Heart Failure.
Presence of kidney disfunction and age of at least 75 years were predictors of 1-year mortality in this population.
“Although post-discharge disease management, such as closer follow-up and intense monitoring, is well known to reduce subsequent mortality and health care costs for patients without congenital heart disease, it remains unclear what should be the duration of intensified patient care in the adult congenital heart disease population,” Fei Wang, PhD, of the department of epidemiology, biostatistics, and occupational health at McGill University in Montreal, and colleagues wrote.
For this study, researchers used the Québec CHD database to identify patients with adult congenital heart disease who were aged at least 40 years, and they performed a propensity score-matched analysis to determine the possible association between incident HF hospitalizations and mortality.
Researchers reported that the risk for mortality among patients with adult congenital heart disease and incident HF hospitalization was considerably elevated after discharge, but declined by 1 year after discharge vs. adults with congenital heart disease but without HF hospitalization. The risk remained high, but declined as years passed:
- at 1 month (HR = 24.56; 95% CI, 14.35-89.6);
- at 1 year (HR = 6.01; 95% CI, 4.02-10.72);
- at 2 years (HR = 3.73; 95% CI, 2.55-6.09);
- at 3 years (HR = 3.49; 95% CI, 2.34-5.58);
- at 4 years (HR = 3.23; 95% CI, 1.9-6.56); and
- at 5 years (HR = 1.65; 95% CI, 0.93-3.57).
The researchers found a strong relationship between kidney dysfunction and risk for 1-year mortality in the HF hospitalization cohort compared with the nonhospitalized group (HR = 2.28; 95% CI, 1.59-3.28).
Patients aged at least 75 years experienced a 66% greater risk for death compared with patients aged 40 to 54 years (HR = 1.66; 95% CI, 0.96-2.85).
Moreover, patients with at least two prior HF hospitalizations in the previous 12 months experienced a 77% greater risk for 1-year mortality compared with patients without readmissions (HR = 1.77; 95% CI, 1.18-2.66).
Patients with an atrial arrhythmia were also at elevated risk for 1-year mortality compared with patients without atrial arrhythmia (HR = 1.51; 95% CI, 1.06-2.14).
“These findings can inform evidence-based decision-making about the care and disposition of patients with adult congenital heart disease with HF,” the researchers wrote. “Additional studies should be conducted to evaluate the effect of possible interventions on the identified predictors and the link between predictors identified and clinical markers of HF.”
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