Specialized ACHD care reduced mortality by 31% (OR 0.69) in adults with congenital heart disease and incident heart failure, with women and cancer patients at higher death risk.
What are the prognostic markers and mortality outcomes for adults with congenital heart disease and incident heart failure compared to non-ACHD heart failure?
Adults with congenital heart disease and incident heart failure face a high mortality risk, but receiving care in specialized ACHD centers is associated with significantly improved survival.
Absolute Event Rate: 0% vs 0%
Abstract Background Heart failure (HF) is a major cause of mortality in adults with congenital heart disease (ACHD), yet prognostic markers remain poorly defined. Purpose We aimed to characterize incident ACHD-related HF and explore prognostic markers of mortality in this population. Methods We analyzed nationwide data from the French National Hospitalization Database (2014–2022). Adult patients (≥18 years) were categorized into three cohorts using ICD-10 codes: ACHD-HF (patients with both CHD and HF), non-ACHD HF (HF patients without CHD), and ACHD without HF (CHD patients without HF). Patients with prior HF hospitalizations (2014–2015) were excluded to ensure incident cases. Results Among 1,792,423 patients hospitalized for incident HF, 8,706 (0.48%) had ACHD, accounting for 23.5% of all ACHD hospitalizations. Over 50% of HF hospitalizations in patients aged 18–50 were attributable to ACHD. Compared to non-ACHD HF, ACHD-HF patients had more modifiable risk factors (34.3% vs. 22.4%, p0.01), lived farther from referral centres (45.60 ±49.18 vs. 25.56 ±29.80, p0.01), and were more frequently hospitalized in non-specialized centres (50.9% vs. 41.5%, p 0.01). During follow-up, 895 (10.3%) of ACHD-HF patients died, with HF being the related cause of death in 46.8% of ACHD cases. Mortality was significantly lower than in non-ACHD HF, even after propensity-score matching (Figure 1, p 0.01). However, this difference was only observed during the first month following the initial HF hospitalization. In multivariate analysis, female sex (OR 1.50; 95% CI 1.26–1.79; p 0.001) and cancer (OR 1.37; 95% CI 1.10–1.71; p 0.001) were independent predictors of death, while specialized ACHD care was associated with lower mortality (OR 0.69; 95% CI 0.55–0.86; p 0.001). Conclusion ACHD patients with HF face a high mortality risk, particularly women and those with cancer. Specialized ACHD care is associated with improved survival, highlighting the need for targeted management strategies.Figure 1
Ladouceur et al. (Sat,) reported a other. Specialized ACHD care reduced mortality by 31% (OR 0.69) in adults with congenital heart disease and incident heart failure, with women and cancer patients at higher death risk.