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Griffeth EM, Stephens EH, Dearani JA, Shreve JT, O'Sullivan D, Egbe AC, Connolly HM, Todd A, Burchill LJ. Impact of heart failure on reoperation in adult congenital heart disease: An innovative machine learning model. J Thorac Cardiovasc Surg 2024; 167:2215-2225.e1. [PMID: 37776991 PMCID: PMC10972775 DOI: 10.1016/j.jtcvs.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES The study objectives were to evaluate the association between preoperative heart failure and reoperative cardiac surgical outcomes in adult congenital heart disease and to develop a risk model for postoperative morbidity/mortality. METHODS Single-institution retrospective cohort study of adult patients with congenital heart disease undergoing reoperative cardiac surgery between January 1, 2010, and March 30, 2022. Heart failure defined clinically as preoperative diuretic use and either New York Heart Association Class II to IV or systemic ventricular ejection fraction less than 40%. Composite outcome included operative mortality, mechanical circulatory support, dialysis, unplanned noncardiac reoperation, persistent neurologic deficit, and cardiac arrest. Multivariable logistic regression and machine learning analysis using gradient boosting technology were performed. Shapley statistics determined feature influence, or impact, on model output. RESULTS Preoperative heart failure was present in 376 of 1011 patients (37%); those patients had longer postoperative length of stay (6 [5-8] vs 5 [4-7] days, P < .001), increased postoperative mechanical circulatory support (21/376 [6%] vs 16/635 [3%], P = .015), and decreased long-term survival (84% [80%-89%] vs 90% [86%-93%]) at 10 years (P = .002). A 7-feature machine learning risk model for the composite outcome achieved higher area under the curve (0.76) than logistic regression, and ejection fraction was most influential (highest mean |Shapley value|). Additional risk factors for the composite outcome included age, number of prior cardiopulmonary bypass operations, urgent/emergency procedure, and functionally univentricular physiology. CONCLUSIONS Heart failure is common among adult patients with congenital heart disease undergoing cardiac reoperation and associated with longer length of stay, increased postoperative mechanical circulatory support, and decreased long-term survival. Machine learning yields a novel 7-feature risk model for postoperative morbidity/mortality, in which ejection fraction was the most influential.
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Affiliation(s)
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | | | - Alexander C Egbe
- Division of Structural Heart Disease, Mayo Clinic, Rochester, Minn
| | - Heidi M Connolly
- Division of Structural Heart Disease, Mayo Clinic, Rochester, Minn
| | - Austin Todd
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minn
| | - Luke J Burchill
- Division of Structural Heart Disease, Mayo Clinic, Rochester, Minn.
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2
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Schamroth Pravda N, Kalter‐Leibovici O, Nir A, Lorber A, Dadashev A, Hirsch R, Benderly M. Arrhythmia Burden Among Adult Patients With Congenital Heart Disease: A Population-Based Study. J Am Heart Assoc 2024; 13:e031760. [PMID: 38629435 PMCID: PMC11179882 DOI: 10.1161/jaha.123.031760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/08/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND A significant percentage of patients with congenital heart disease surviving into adulthood will develop arrhythmias. These arrhythmias are associated with an increased risk of adverse events and death. We aimed to assess arrhythmia prevalence, risk factors, and associated health care usage in a large national cohort of patients with adult congenital heart disease. METHODS AND RESULTS Adults with a documented diagnosis of congenital heart disease, insured by Clalit and Maccabi health services between January 2007 and December 2011, were included. We assessed the associations between arrhythmia and subsequent hospitalization rates and death with mixed negative binomial and Cox proportional hazard models, respectively. Among 11 653 patients with adult congenital heart disease (median age, 47 years [interquartile range, 31-62]), 8.7% had a tachyarrhythmia at baseline, 1.5% had a conduction disturbance, and 0.5% had both. Among those without a baseline arrhythmia, 9.2% developed tachyarrhythmias, 0.9% developed a conduction disturbance, and 0.3% developed both during the study period. Compared with no arrhythmia (reference group), arrhythmia in the previous 6 months was associated with a higher multivariable adjusted hospitalization rate, 1.33-fold higher than the rate of the reference group (95% CI, 1.00-1.76) for ventricular arrhythmia, 1.27-fold higher (95% CI, 1.17-1.38) for atrial arrhythmias, and 1.33-fold higher (95% CI, 1.04-1.71) for atrioventricular block. Atrial tachyarrhythmias were associated with an adjusted mortality hazard ratio (HR) of 1.65 (95% CI, 1.44-2.94), and ventricular tachyarrhythmias with a >2-fold increase in mortality risk (HR, 2.06 [95% CI, 1.44-2.94]). CONCLUSIONS Arrhythmias are significant comorbidities in the adult congenital heart disease population and have a significant impact on health care usage and survival.
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Affiliation(s)
- Nili Schamroth Pravda
- Department of CardiologyAdult Congenital Heart Disease Unit, Rabin Medical CenterPetach TikvaIsrael
| | - Ofra Kalter‐Leibovici
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical CenterRamat‐GanIsrael
- Faculty of Medicine and Health SciencesTel Aviv UniversityTel AvivIsrael
| | - Amiram Nir
- Pediatric Cardiology and Adult Congenital Heart Disease Unit, Shaare Zedek Medical CenterJerusalemIsrael
| | - Avraham Lorber
- Pediatric Cardiology and GUCH Unit, Rambam Health Care CampusHaifaIsrael
| | - Alexander Dadashev
- Department of CardiologyAdult Congenital Heart Disease Unit, Rabin Medical CenterPetach TikvaIsrael
- Faculty of Medicine and Health SciencesTel Aviv UniversityTel AvivIsrael
| | - Rafael Hirsch
- Department of CardiologyAdult Congenital Heart Disease Unit, Rabin Medical CenterPetach TikvaIsrael
- Faculty of Medicine and Health SciencesTel Aviv UniversityTel AvivIsrael
| | - Michal Benderly
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical CenterRamat‐GanIsrael
- Faculty of Medicine and Health SciencesTel Aviv UniversityTel AvivIsrael
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Ladouceur M, Bouchardy J. Epidemiology and Definition of Heart Failure in Adult Congenital Heart Disease. Heart Fail Clin 2024; 20:113-127. [PMID: 38462316 DOI: 10.1016/j.hfc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Adults with congenital heart disease (ACHD) are facing lifelong complications, notably heart failure (HF). This review focuses on classifications, incidence, prevalence, and mortality of HF related to ACHD. Diagnosing HF in ACHD is intricate due to anatomic variations, necessitating comprehensive clinical evaluations. Hospitalizations and resource consumption for ACHD HF have significantly risen compared with non-ACHD HF patients. With more than 30% prevalence in complex cases, HF has become the leading cause of death in ACHD. These alarming trends underscore the insufficient understanding of ACHD-related HF manifestations and management challenges within the context of aging, complexity, and comorbidity.
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Affiliation(s)
- Magalie Ladouceur
- Department of Cardiology, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland; Centre de Recherche Cardiovasculaire de Paris, INSERM U970, 56 rue Leblanc, Paris 75015, France.
| | - Judith Bouchardy
- Department of Cardiology, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland
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Nicolarsen J, Mudd J, Coletti A. Medical Therapy and Monitoring in Adult Congenital Heart Disease Heart Failure. Heart Fail Clin 2024; 20:137-146. [PMID: 38462318 DOI: 10.1016/j.hfc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Heart failure (HF) in adult congenital heart disease (ACHD) is an increasingly common problem facing ACHD and advanced heart disease and transplant providers. Patients are highly nuanced, and therapies are poorly studied. Standard HF medications are often used in patients who are not targets of large clinical trials. HF management in this data-free zone requires focused, comprehensive team-based care and close follow-up and communication with patients.
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Affiliation(s)
- Jeremy Nicolarsen
- Providence Adult and Teen Congenital Heart Program (PATCH), Providence Sacred Heart Medical Center and Children's Hospital, 101 West 8th Avenue, Suite 4300, Spokane, WA 99204, USA.
| | - James Mudd
- Center for Advanced Heart Disease and Transplantation, Providence Spokane Heart Institute, 62 West 7th Avenue, Suite 232, Spokane, WA 99204, USA
| | - Andrew Coletti
- Center for Advanced Heart Disease and Transplantation, Providence Spokane Heart Institute, 62 West 7th Avenue, Suite 232, Spokane, WA 99204, USA
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Shakya S, Cary MP. Hospital Utilization for Coronary Artery Disease, 1997-2014. J Cardiovasc Nurs 2024; 39:153-159. [PMID: 36594990 DOI: 10.1097/jcn.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of cardiovascular morbidity, mortality, and healthcare costs in the United States. There are few reports on how public health and payment reforms might have influenced inpatient hospital use among patients with CAD. OBJECTIVE This study describes trends in hospital discharges, hospital charges, and discharge destinations in a national sample of patients with CAD between 1997 and 2014. METHODS This was a longitudinal study with descriptive analysis of the Healthcare Cost and Utilization Project of National Inpatient Sample data. FINDINGS During this study period, the total number of discharges was 1 333 996. Patients with CAD between 65 and 84 years old were among the highest users of inpatient hospital services, followed by those in the 45- to 64-year age group. The death rate increased from 5961 to 7217 per 10 000 patients during this time. The mean charge increased more than 5 times, from $9100 to $49 643. There was a large difference in mean hospital charges in urban ($51 666) and rural ($25 548) locations in 2014. Coronary artery disease patients with private insurance paid more than those with Medicaid and Medicare plans. The discharge to home and healthcare costs increased by 4.1% and 4.8%, respectively. CONCLUSION AND IMPLICATIONS Future researchers should use data sets, such as Medicare claims/Medical Expenditure Panel Study, that can provide comprehensive insights into patient-level factors influencing the use of inpatient care services among patients with CAD. Healthcare providers in posthospital settings should be well skilled in providing advanced cardiac rehabilitation and education to patients with CAD.
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Keshavarzi R, Divsalar P, Aliramezany M. Prevalence of anxiety and depression in adult patients with CHD. Cardiol Young 2023:1-6. [PMID: 38057138 DOI: 10.1017/s1047951123004079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
INTRODUCTION CHD are among the most common congenital defects. Due to the chronic nature of CHD, patients face various risk factors that threaten their mental health. However, a comprehensive understanding of the medical and social predictors of mental health issues in adults with CHD is lacking. This study aims to investigate the prevalence of anxiety and depression in adults with CHD. METHODS This cross-sectional descriptive study focused on adults with CHD in Kerman, Iran. The participants completed demographic information alongside two psychological assessment tools: the Beck Anxiety Inventory (BAI) and the Depression Anxiety Stress Scales (DASS)-21. The data were analyzed using SPSS 26. FINDINGS The mean age of the participants was 29.94 ± 12.36 years, and 63.8% were female. According to the DASS, 73.4% did not have depression, 61% did not have anxiety, and 76.2% did not have stress. In total, 19% had mild stress, and 4.8% had moderate stress. According to the BAI, 27.6% did not have anxiety. Individual characteristics were not significantly associated with depression. However, gender, age, and type of surgery were significantly associated with anxiety. Cyanosis was significantly associated with stress. CONCLUSION The results show that mental disorders like depression, anxiety, and stress are highly prevalent in adults with CHD. The prevalence depends on individual factors such as age, gender, and disease severity. Therefore, it is recommended that mental disorders in this population be evaluated and treated accurately.
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Affiliation(s)
| | | | - Maryam Aliramezany
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Agasthi P, Van Houten HK, Yao X, Jain CC, Egbe A, Warnes CA, Miranda WR, Dunlay SM, Stephens EH, Johnson JN, Connolly HM, Burchill LJ. Mortality and Morbidity of Heart Failure Hospitalization in Adult Patients With Congenital Heart Disease. J Am Heart Assoc 2023; 12:e030649. [PMID: 38018491 PMCID: PMC10727341 DOI: 10.1161/jaha.123.030649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Little is known about outcomes following heart failure (HF) hospitalization among adults with congenital heart disease (CHD) in the United States. We aim to compare the outcomes of HF versus non-HF hospitalizations in adults with CHD. METHODS AND RESULTS Using a national deidentified administrative claims data set, patients with adult congenital heart disease (ACHD) hospitalized with and without HF (ACHDHF+, ACHDHF-) were characterized to determine the predictors of 90-day and 1-year mortality and quantify the risk of mortality, major adverse cardiac and cerebrovascular events, and health resource use. Cox proportional hazard regression was used to compare ACHDHF+ versus ACHDHF- for risk of events and health resource use. Of 26 454 unique ACHD admissions between January 1, 2010 and December 31, 2020, 5826 (22%) were ACHDHF+ and 20 628 (78%) were ACHDHF-. The ACHD HF+ hospitalizations increased from 6.6% to 14.0% (P<0.0001). Over a mean follow-up period of 2.23 ± 2.19 years, patients with ACHDHF+ had a higher risk of mortality (hazard ratio [HR], 1.86 [95% CI, 1.67-2.07], P<0.001), major adverse cardiac and cerebrovascular events (HR, 1.73 [95% CI, 1.63-1.83], P<0.001) and health resource use including rehospitalization (HR, 1.09 [95% CI, 1.05-1.14], P<0.001) and increased postacute care service use (HR, 1.56 [95% CI, 1.32-1.85], P<0.001). Cardiology clinic visits within 30 days of hospital admission were associated with lower 90-day and 1-year all-cause mortality (odds ratio [OR], 0.62 [95% CI, 0.49-0.78], P<0.001; OR, 0.69 [95% CI, 0.58-0.83], P<0.001, respectively). CONCLUSIONS HF hospitalization is associated with increased risk of mortality and morbidity with high health resource use in patients with ACHD. Recent cardiology clinic attendance appears to mitigate these risks.
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Affiliation(s)
| | - Holly K. Van Houten
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo ClinicRochesterMNUSA
- OptumLabsMinnetonkaMNUSA
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo ClinicRochesterMNUSA
- OptumLabsMinnetonkaMNUSA
| | - C. Charles Jain
- Department of Cardiovascular Medicine, Mayo ClinicRochesterMNUSA
| | - Alexander Egbe
- Department of Cardiovascular Medicine, Mayo ClinicRochesterMNUSA
| | - Carole A. Warnes
- Department of Cardiovascular Medicine, Mayo ClinicRochesterMNUSA
| | | | - Shannon M. Dunlay
- Department of Cardiovascular Medicine, Mayo ClinicRochesterMNUSA
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo ClinicRochesterMNUSA
| | | | - Jonathan N. Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children’s CenterRochesterMNUSA
| | | | - Luke J. Burchill
- Department of Cardiovascular Medicine, Mayo ClinicRochesterMNUSA
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8
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Abdelrehim AA, Dearani JA, Holst KA, Miranda WR, Connolly HM, Todd AL, Burchill LJ, Schaff HV, Pochettino A, Stephens EH. Risk factors and early outcomes of repeat sternotomy in 1960 adults with congenital heart disease: A 30-year, single-center study. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01090-5. [PMID: 37981102 DOI: 10.1016/j.jtcvs.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Patients with congenital heart disease (CHD) increasingly live into adulthood, often requiring cardiac reoperation. We aimed to assess the outcomes of adults with CHD (ACHD) undergoing repeat sternotomy at our institution. METHODS Review of our institution's cardiac surgery database identified 1960 ACHD patients undergoing repeat median sternotomy from 1993 to 2023. The primary outcome was early mortality, and the secondary outcome was a composite end point of mortality and significant morbidity. Univariable and multivariable logistic regression models were used to determine factors independently associated with outcomes. RESULTS Of the 1960 ACHDs patient undergoing repeat sternotomy, 1183 (60.3%) underwent a second, third (n = 506, 25.8%), fourth (n = 168, 8.5%), fifth (n = 70, 3.5%), and sixth sternotomy or greater (n = 33, 1.6%). CHD diagnoses were minor complexity (n = 145, 7.4%), moderate complexity (n = 1380, 70.4%), and major complexity (n = 435, 22.1%). Distribution of procedures included valve (n = 549, 28%), congenital (n = 625, 32%), aortic (n = 104, 5.3%), and major procedural combinations (n = 682, 34.7%). Overall early mortality was 3.1%. Factors independently associated with early mortality were older age at surgery, CHD of major complexity, preoperative renal failure, preoperative ejection fraction, urgent operation, and postoperative blood transfusion. In addition, sternotomy number and bypass time were independently associated with the composite outcome. CONCLUSIONS Despite the increase in early mortality with sternotomy number, sternotomy number was not independently associated with early mortality but with increased morbidity. Improvement strategies should target factors leading to urgent operations, early referral, along with operative efficiency including bypass time and blood conservation.
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Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Austin L Todd
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Luke J Burchill
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
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Seri A, Baral N, Yousaf A, Sriramoju A, Chinta SR, Agasthi P. Outcomes of Heart Failure Hospitalizations in Adult Patients With Coarctation of Aorta: Report From National Inpatient Sample. Curr Probl Cardiol 2023; 48:101888. [PMID: 37343776 DOI: 10.1016/j.cpcardiol.2023.101888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
Coarctation of aorta (CoA) is a common congenital anomaly which portends patients to early diastolic and systolic heart failure. In this retrospective cohort study, we aimed to evaluate the impact of CoA on heart failure hospitalization. Using the national inpatient sample, the study compared the outcomes of heart failure hospitalization between patients with and without CoA. We noted increasing prevalence of CoA related heart failure admissions over the last decade. Heart failure patients with CoA were younger (mean age 57 vs 71.6 years, P < 0.001), had a longer length of stay (7.4 vs 5.4 days, P < 0.001), and a higher incidence of cardiogenic shock (6.5% vs 2.1%, P = 0.001). However, there was no statistically significant difference in in-hospital mortality (OR 1.45, 95% CI: 0.58, 3.62, P = 0.421) between both groups. These findings demonstrate that CoA increase healthcare resource utilization in patients admitted with heart failure without any significant increase in in-hospital mortality.
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Affiliation(s)
- Amith Seri
- Department of Internal Medicine, McLaren Health Care and Michigan State University, Flint, MI
| | - Nischit Baral
- Department of Internal Medicine, McLaren Health Care and Michigan State University, Flint, MI
| | - Amman Yousaf
- Department of Internal Medicine, McLaren Health Care and Michigan State University, Flint, MI
| | - Anil Sriramoju
- Department of Internal Medicine, University of North Dakota, Fargo, ND
| | - Siddharth Reddy Chinta
- Division of Cardiology, Department of Internal Medicine, Tufts medical center, Boston, MA
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10
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Edelson JB, Zhang X, Goldstone AB, Rossano JW, O’Connor MJ, Gaynor JW, Edwards JJ, Wittlieb-Weber C, Maeda K. Reduced incidence of cardiac rejection in multi-organ transplants: A propensity matched study. Clin Transplant 2023; 37:e15019. [PMID: 37212365 PMCID: PMC11161140 DOI: 10.1111/ctr.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Rejection remains a primary cause of graft loss after heart transplant (HT). Recognizing the immunomodulation of multi-organ transplant can enhance our understanding of the mechanisms of cardiac rejection. METHODS This retrospective cohort study identified patients from the UNOS database with isolated heart (H, N = 37 433), heart-kidney (HKi, N = 1516), heart-liver (HLi, N = 286), and heart-lung (HLu, N = 408) transplants from 2004 to 2019. Propensity score matching reduced baseline differences between groups. Outcomes included risk of rejection prior to transplant hospital discharge and within 1 year, and mortality within 1 year of transplant. RESULTS In the propensity score matched data, the relative risk of being treated for rejection prior to transplant hospital discharge was 61% lower for HKi (RR .39, 95% CI .29, .53) and 87% lower for HLi (RR .13, 95% CI .05, .37) compared to H. Similarly, the probability of being treated for rejection in the first year after transplant remained lower in HKi (RR .45, 95% CI .35, .57) and HLi (RR .13, 95% CI .06, .28) compared to H. The 1-year survival analysis revealed an equivalent risk of death in HKi (HR .84, 95% CI .68, 1.03) and HLi (HR 1.41, 95% CI .83, 2.41) compared to H, while HLu had a higher risk of death in the first year after transplant (HR 1.65, 95% CI 1.17, 2.33). CONCLUSIONS Recipients of HKi and HLi experience a reduced risk of rejection when compared to H, but an equivalent risk of 1 yr mortality. These findings have important implications for the future of HT medicine.
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Affiliation(s)
- Jonathan B. Edelson
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xuemei Zhang
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew B. Goldstone
- Division of Cardiac, Thoracic, and Vascular Surgery at the NYP/Morgan Stanley Children’s Hospital at Columbia University Irving Medical Center
| | - Joseph W. Rossano
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew J. O’Connor
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J. William Gaynor
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Jonathan J. Edwards
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carol Wittlieb-Weber
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katsuhide Maeda
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA
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Su Z, Zhang Y, Cai X, Li Q, Gu H, Luan Y, He Y, Li S, Chen J, Zhang H. Improving long-term care and outcomes of congenital heart disease: fulfilling the promise of a healthy life. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:502-518. [PMID: 37301214 DOI: 10.1016/s2352-4642(23)00053-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/16/2023] [Accepted: 02/28/2023] [Indexed: 06/12/2023]
Abstract
Advances in the prevention, diagnosis, and treatment for congenital heart disease (CHD), the most common birth defect in China, have drastically improved survival for individuals with the disease. However, China's current health system is not well prepared to manage the growing population of people with CHD and their complex medical needs, which range from early detection of the condition and intervention for physical, neurodevelopmental, and psychosocial impairment, to long-term management of major complications and chronic health problems. Health disparities caused by long-standing regional differences in access to care pose challenges when major complications such as pulmonary hypertension arise, and when individuals with complex CHD become pregnant and give birth. Currently, no data sources track neonates, children, adolescents, and adults with CHD in China and delineate their clinical characteristics and use of health resources. This scarcity of data should warrant attention from the Chinese Government and relevant specialists in the field. In the third paper of the Series on CHD in China, we summarise key literature and current data to identify knowledge gaps and call for concerted efforts by the government, hospitals, clinicians, industries, and charitable organisations to develop an actionable, lifelong framework of congenital cardiac care that is accessible and affordable for all individuals with CHD. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Zhanhao Su
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Department of Cardiovascular Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yunting Zhang
- Child Health Advocacy Institute, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoman Cai
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qiangqiang Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Yihua He
- Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China; Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center and State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of South China, Structural Heart Disease, Guangzhou, China
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Shinkawa T, Ichihara Y, Saito S, Ishido M, Inai K, Niinami H. Ventricular assist device for end-stage adult congenital heart disease patients: Current status. J Cardiol 2023; 81:378-384. [PMID: 36152979 DOI: 10.1016/j.jjcc.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
As long-term surgical outcome of congenital heart disease has continued to improve, most pediatric patients with congenital heart disease are able to reach adulthood. However, adult congenital heart disease (ACHD) patients have increased risk of arrhythmia, valvular diseases, infectious endocarditis, and heart failure. The end-stage ACHD patients with advanced heart failure may require mechanical circulatory support to improve the heart failure symptoms or to recover from circulatory collapse, and may eventually aim to heart transplant or destination therapy. In general, long-term mechanical support for dilated cardiomyopathy or ischemic cardiomyopathy has been achieved with left ventricular assist device with excellent survival outcomes and improved quality of life. However, the ventricular assist device for end-stage ACHD patients can be challenging due to patient-specific anatomical feature, multiple histories of surgical and catheter-based interventions and possible multiple end-organ dysfunctions, and offered less frequently compared to non-ACHD patients. The Interagency Registry for Mechanically Assisted Circulatory Support data published recently showed that ACHD patients receiving long-term mechanical circulatory support consisted <1 % of all registrants and had higher mortality after mechanical support than non-ACHD patients. However, the ACHD patients supported with left ventricular assist device had similar survival with non-ACHD patients and a large proportion of the mortality difference between ACHD and non-ACHD patients seemed to result from operative and perioperative factors. Therefore, the ventricular assist device therapy can be an excellent treatment for selected ACHD patients. In this paper, we describe the current status of ventricular assist device support for end-stage ACHD patients and consideration to the future.
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Affiliation(s)
- Takeshi Shinkawa
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan.
| | - Yuki Ichihara
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan
| | - Satoshi Saito
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan
| | - Mikiko Ishido
- Tokyo Women's Medical University, Department of Pediatric and Adult Congenital Cardiology, Tokyo, Japan
| | - Kei Inai
- Tokyo Women's Medical University, Department of Pediatric and Adult Congenital Cardiology, Tokyo, Japan
| | - Hiroshi Niinami
- Tokyo Women's Medical University, Department of Cardiovascular Surgery, Tokyo, Japan
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13
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El-Chouli M, Meddis A, Christensen DM, Gerds TA, Sehested T, Malmborg M, Phelps M, Bang CN, Ahlehoff O, Torp-Pedersen C, Sindet-Pedersen C, Raunsø J, Idorn L, Gislason G. Lifetime risk of comorbidity in patients with simple congenital heart disease: a Danish nationwide study. Eur Heart J 2022; 44:741-748. [PMID: 36477305 PMCID: PMC9976987 DOI: 10.1093/eurheartj/ehac727] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS In a continuously ageing population of patients with congenital heart disease (CHD), understanding the long-term risk of morbidity is crucial. The aim of this study was to compare the lifetime risks of developing comorbidities in patients with simple CHD and matched controls. METHODS AND RESULTS Using the Danish nationwide registers spanning from 1977 to 2018, simple CHD cases were defined as isolated atrial septal defect (ASD), ventricular septal defect (VSD), pulmonary stenosis, or patent ductus arteriosus in patients surviving until at least 5 years of age. There were 10 controls identified per case. Reported were absolute lifetime risks and lifetime risk differences (between patients with simple CHD and controls) of incident comorbidities stratified by groups and specific cardiovascular comorbidities. Of the included 17 157 individuals with simple CHD, the largest subgroups were ASD (37.7%) and VSD (33.9%), and 52% were females. The median follow-up time for patients with CHD was 21.2 years (interquartile range: 9.4-39.0) and for controls, 19.8 years (9.0-37.0). The lifetime risks for the investigated comorbidities were higher and appeared overall at younger ages for simple CHD compared with controls, except for neoplasms and chronic kidney disease. The lifetime risk difference among the comorbidity groups was highest for neurological disease (male: 15.2%, female: 11.3%), pulmonary disease (male: 9.1%, female: 11.7%), and among the specific comorbidities for stroke (male: 18.9%, female: 11.4%). The overall risk of stroke in patients with simple CHD was mainly driven by ASD (male: 28.9%, female: 17.5%), while the risks of myocardial infarction and heart failure were driven by VSD. The associated lifetime risks of stroke, myocardial infarction, and heart failure in both sexes were smaller in invasively treated patients compared with untreated patients with simple CHD. CONCLUSION Patients with simple CHD had increased lifetime risks of all comorbidities compared with matched controls, except for neoplasms and chronic kidney disease. These findings highlight the need for increased attention towards early management of comorbidity risk factors.
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Affiliation(s)
| | - Alessandra Meddis
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas A Gerds
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Sehested
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Roskilde University Hospital, Zealand, Denmark
| | - Morten Malmborg
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Matthew Phelps
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Departments of Clinical Investigation and Cardiology, North Zealand University Hospital, Hillerød, Denmark
| | | | - Jakob Raunsø
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Lars Idorn
- Department of Pediatric Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Graziani F, Iannaccone G, Meucci MC, Lillo R, Delogu AB, Grandinetti M, Perri G, Galletti L, Amodeo A, Butera G, Secinaro A, Lombardo A, Lanza GA, Burzotta F, Crea F, Massetti M. Impact of severe valvular heart disease in adult congenital heart disease patients. Front Cardiovasc Med 2022; 9:983308. [DOI: 10.3389/fcvm.2022.983308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022] Open
Abstract
BackgroundThe clinical impact of valvular heart disease (VHD) in adult congenital heart disease (ACHD) patients is unascertained. Aim of our study was to assess the prevalence and clinical impact of severe VHD (S-VHD) in a real-world contemporary cohort of ACHD patients.Materials and methodsConsecutive patients followed-up at our ACHD Outpatient Clinic from September 2014 to February 2021 were enrolled. Clinical characteristics and echocardiographic data were prospectively entered into a digitalized medical records database. VHD at the first evaluation was assessed and graded according to VHD guidelines. Clinical data at follow-up were collected. The study endpoint was the occurrence of cardiac mortality and/or unplanned cardiac hospitalization during follow-up.ResultsA total of 390 patients (median age 34 years, 49% males) were included and S-VHD was present in 101 (25.9%) patients. Over a median follow-up time of 26 months (IQR: 12–48), the study composite endpoint occurred in 76 patients (19.5%). The cumulative endpoint-free survival was significantly lower in patients with S-VHD vs. patients with non-severe VHD (Log rank p < 0.001). At multivariable analysis, age and atrial fibrillation at first visit (p = 0.029 and p = 0.006 respectively), lower %Sat O2, higher NYHA class (p = 0.005 for both), lower LVEF (p = 0.008), and S-VHD (p = 0.015) were independently associated to the study endpoint. The likelihood ratio test demonstrated that S-VHD added significant prognostic value (p = 0.017) to a multivariate model including age, severe CHD, atrial fibrillation, %Sat O2, NYHA, LVEF, and right ventricle systolic pressure > 45 mmHg.ConclusionIn ACHD patients, the presence of S-VHD is independently associated with the occurrence of cardiovascular mortality and hospitalization. The prognostic value of S-VHD is incremental above other established prognostic markers.
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15
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Ganti VG, Gazi AH, An S, Srivatsa AV, Nevius BN, Nichols CJ, Carek AM, Fares M, Abdulkarim M, Hussain T, Greil FG, Etemadi M, Inan OT, Tandon A. Wearable Seismocardiography‐Based Assessment of Stroke Volume in Congenital Heart Disease. J Am Heart Assoc 2022; 11:e026067. [DOI: 10.1161/jaha.122.026067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Patients with congenital heart disease (CHD) are at risk for the development of low cardiac output and other physiologic derangements, which could be detected early through continuous stroke volume (SV) measurement. Unfortunately, existing SV measurement methods are limited in the clinic because of their invasiveness (eg, thermodilution), location (eg, cardiac magnetic resonance imaging), or unreliability (eg, bioimpedance). Multimodal wearable sensing, leveraging the seismocardiogram, a sternal vibration signal associated with cardiomechanical activity, offers a means to monitoring SV conveniently, affordably, and continuously. However, it has not been evaluated in a population with significant anatomical and physiological differences (ie, children with CHD) or compared against a true gold standard (ie, cardiac magnetic resonance). Here, we present the feasibility of wearable estimation of SV in a diverse CHD population (N=45 patients).
Methods and Results
We used our chest‐worn wearable biosensor to measure baseline ECG and seismocardiogram signals from patients with CHD before and after their routine cardiovascular magnetic resonance imaging, and derived features from the measured signals, predominantly systolic time intervals, to estimate SV using ridge regression. Wearable signal features achieved acceptable SV estimation (28% error with respect to cardiovascular magnetic resonance imaging) in a held‐out test set, per cardiac output measurement guidelines, with a root‐mean‐square error of 11.48 mL and
R
2
of 0.76. Additionally, we observed that using a combination of electrical and cardiomechanical features surpassed the performance of either modality alone.
Conclusions
A convenient wearable biosensor that estimates SV enables remote monitoring of cardiac function and may potentially help identify decompensation in patients with CHD.
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Affiliation(s)
- Venu G. Ganti
- Bioengineering Graduate Program Georgia Institute of Technology Atlanta GA
| | - Asim H. Gazi
- School of Electrical and Computer Engineering Georgia Institute of Technology Atlanta GA
| | - Sungtae An
- School of Interactive Computing Georgia Institute of Technology Atlanta GA
| | - Adith V. Srivatsa
- The Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology Atlanta GA
| | - Brandi N. Nevius
- School of Mechanical Engineering Georgia Institute of Technology Atlanta GA
| | - Christopher J. Nichols
- The Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology Atlanta GA
| | - Andrew M. Carek
- Department of Biomedical Engineering, McCormick School of Engineering Northwestern University Evanston IL
- Department of Anesthesiology, Feinberg School of Medicine Northwestern University Evanston IL
| | - Munes Fares
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
| | - Mubeena Abdulkarim
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
| | - Tarique Hussain
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
| | - F. Gerald Greil
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
| | - Mozziyar Etemadi
- Department of Biomedical Engineering, McCormick School of Engineering Northwestern University Evanston IL
- Department of Anesthesiology, Feinberg School of Medicine Northwestern University Evanston IL
| | - Omer T. Inan
- Bioengineering Graduate Program Georgia Institute of Technology Atlanta GA
- School of Electrical and Computer Engineering Georgia Institute of Technology Atlanta GA
| | - Animesh Tandon
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas TX
- Cleveland Clinic Children’s Cleveland OH
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16
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Qu Y, Zhou X, Liu X, Wang X, Yang B, Chen G, Guo Y, Nie Z, Ou Y, Gao X, Wu Y, Dong G, Zhuang J, Chen J. Risk of maternal exposure to mixed air pollutants during pregnancy for congenital heart diseases in offspring. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:326-333. [PMID: 36207835 PMCID: PMC9511474 DOI: 10.3724/zdxbyxb-2022-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore the risk of maternal exposure to mixed air pollutants of particulate matter 1 (PM 1), particulate matter 2.5 (PM 2.5), particulate matter 10 (PM 10) and NO 2 for congenital heart disease (CHD) in offspring, and to estimate the ranked weights of the above pollutants. METHODS 6038 CHD patients and 5227 healthy controls from 40 medical institutions in 21 cities in Guangdong Registry of Congenital Heart Disease (GRCHD) from 2007 to 2016 were included. Logistic regression model was used to estimate the effect of maternal exposure to a single air pollutant on the occurrence of CHD in offspring. Spearman correlation coefficient was used to analyze the correlation between various pollutants, and Quantile g-computation was used to evaluate the joint effects of mixed exposure of air pollutants on CHD and the weights of various pollutants. RESULTS The exposure levels of PM 1, PM 2.5, PM 10 and NO 2 in the CHD group were significantly higher than those in the control group (all P<0.01). The correlation coefficients among PM 1, PM 2.5, PM 10 and NO 2 were greater than 0.80. PM 1, PM 2.5, PM 10 and NO 2 exposure were associated with a significantly increased risk of CHD in offspring. Mixed exposure of these closely correlated pollutants presented much stronger effect on CHD than exposure of any single pollutants. There was a monotonic increasing relationship between mixed exposure and CHD risk. For each quantile increase in mixed exposure, the risk of CHD increased by 47% ( OR=1.47, 95% CI: 1.34-1.61). Mixed exposure had greater effect on CHD in the early pregnancy compared with middle and late pregnancy, but the greatest effect was the exposure in the whole pregnancy. The weight of PM 10 is the highest in the mixed exposure (81.3%). CONCLUSIONS Maternal exposure to the mixture of air pollutants during pregnancy increases the risk of CHD in offspring, and the effect is much stronger than that of single exposure of various pollutants. PM 10 has the largest weights and the strongest effect in the mixed exposure.
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Affiliation(s)
- Yanji Qu
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xinli Zhou
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiaoqing Liu
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ximeng Wang
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Boyi Yang
- 2. Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Gongbo Chen
- 2. Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
- 3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Yuming Guo
- 3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Zhiqiang Nie
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yanqiu Ou
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiangmin Gao
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yong Wu
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Guanghui Dong
- 2. Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jian Zhuang
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jimei Chen
- 1. Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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17
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Bravo-Jaimes K, Venkatesh P, Lluri G, Reardon L, Cruz D, Vucicevic D, Yang EH, Nsair A, Saggar R, Channick R, Kwon M, Van Arsdell G, Aboulhosn J. Temporary axial-flow mechanical circulatory support and intravenous treprostinil in a patient with D-transposition of the great arteries and atrial switch: A case report. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Brida M, Lovrić D, Griselli M, Gil FR, Gatzoulis MA. Heart failure in adults with congenital heart disease. Int J Cardiol 2022; 357:39-45. [DOI: 10.1016/j.ijcard.2022.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 12/11/2022]
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19
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Townsend M, Jeewa A, Adachi I, Al Aklabi M, Honjo O, Armstrong K, Buchholz H, Conway J. Ventricular Assist Device Use in Single Ventricle Circulation. Can J Cardiol 2022; 38:1086-1099. [DOI: 10.1016/j.cjca.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 01/09/2023] Open
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20
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Khan AM, McGrath LB, Ramsey K, Agarwal A, Slatore CG, Broberg CS. Distance to Care, Rural Dwelling Status, and Patterns of Care Utilization in Adult Congenital Heart Disease. Pediatr Cardiol 2022; 43:532-540. [PMID: 34705069 DOI: 10.1007/s00246-021-02750-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
Many patients with adult congenital heart disease (ACHD) do not receive guideline-directed care. While distance to an ACHD center has been identified as a potential barrier to care, the impact of distance on care location is not well understood. The Oregon All Payer All Claims database was queried to identify subjects 18-65 years who had a health encounter from 2010 to 2015 with an International Classification of Diseases-9 code consistent with ACHD. Residence area was classified using metropolitan statistical areas and driving distance was queried from Google Maps. Utilization rates and percentages were calculated and odds ratios were estimated using negative binomial and logistic regression. Of 10,199 identified individuals, 52.4% lived < 1 h from the ACHD center, 37.5% 1-4 h, and 10.1% > 4 h. Increased distance from the ACHD center was associated with a lower rate of ACHD-specific follow-up [< 1 h: 13.0% vs. > 4 h: 5.0%, adjusted OR 0.32 (0.22, 0.48)], but with more inpatient, emergency room, and outpatient visits overall. Those who more lived more than 4 h from the ACHD center had less inpatient visits at urban hospitals (55.5% vs. 93.9% in those < 1 h) and the ACHD center (6.2% vs. 18.2%) and more inpatient admissions at rural or critical access hospitals (25.5% vs. 1.9%). Distance from the ACHD center was associated with a decreased probability of ACHD follow-up but higher health service use overall. Further work is needed to identify strategies to improve access to specialized ACHD care for all individuals with ACHD.
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Affiliation(s)
- Abigail M Khan
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, 97239, USA.
| | - Lidija B McGrath
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Katrina Ramsey
- Department of Biostatistics, Oregon Health & Science University, Portland, OR, USA
| | - Anushree Agarwal
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.,Division of Pulmonary & Critical Care Medicine, Department of Medicine, and Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, USA
| | - Craig S Broberg
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, 97239, USA
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21
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Aldweib N, Elia EG, Brainard SB, Wu F, Sleeper LA, Rodriquez C, Valente AM, Landzberg MJ, Singh M, Mullen M, Opotowsky AR. Serial cardiac biomarker assessment in adults with congenital heart disease hospitalized for decompensated heart failure. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022; 7. [PMID: 35463849 PMCID: PMC9024322 DOI: 10.1016/j.ijcchd.2022.100336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Biomarkers are increasingly part of assessing and managing heart failure (HF) in adults with congenital heart disease (CHD). Objectives: To understand the response of cardiac biomarkers with therapy for acute decompensated heart failure (ADHF) and the relationship to prognosis after discharge in adults with CHD. Design: A prospective, observational cohort study with serial blood biomarker measurements. Settings: Single-center study in the inpatient setting with outpatient follow-up. Participants: Adults (≥18 years old) with CHD admitted with ADHF between August 1, 2019, and March 1, 2020. Exposure: We measured body mass, Kansas City Cardiomyopathy Questionnaire (KCCQ-12) score, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) at enrollment, discharge, and 1st clinic follow-up visit; soluble suppression of tumorigenicity 2 (sST2) was measured at the first two time points. Measures: Univariate regression assessed the association between changes in weight, biomarkers, and changes in KCCQ-12 scores, between enrollment and discharge (ΔHospitalization) and between discharge and 1st clinical follow-up visit (ΔPost−discharge). Wilcoxon rank-sum tests assessed the association between change in biomarkers, KCCQ-12 scores, and the composite outcome of cardiovascular death or rehospitalization for ADHF. Results: A total of 26 patients were enrolled. The median age was 51.9 years [IQR: 38.8, 61.2], 13 (54.2%) were women, and median hospital stay was 6.5 days [IQR: 4.0, 15.0] with an associated weight loss of 2.8 kg [IQR −5.1, −1.7]. All three cardiac biomarkers decreased during hospitalization with diuresis while KCCQ-12 scores improved; a greater decrease in sST2 was associated with an improved KCCQ-12 symptom frequency (SF) subdomain score (p = 0.012), but otherwise, there was no significant relationship between biomarkers and KCCQ-12 change. Change in hsCRP and NT-proBNP after discharge was not associated with the composite outcome (n = 8, vs. n = 16 who did not experience the outcome; Δ Post-discharge hsCRP +5.1 vs. −1.0 mg/l, p = 0.061; NT-proBNP +785.0 vs. +130.0 pg/ml, p = 0.220). Conclusions: Serial biomarker measurements respond to acute diuresis in adults with CHD hospitalized for ADHF. These results should motivate further research into the use of biomarkers to inform HF therapy in adults with CHD.
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Affiliation(s)
- Nael Aldweib
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Corresponding author. Knight Cardiovascular Institute, Oregon Health Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States. , (N. Aldweib)
| | - Eleni G. Elia
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Sarah B. Brainard
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Fred Wu
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Carla Rodriquez
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Anne Marie Valente
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Michael J. Landzberg
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Michael Singh
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Mary Mullen
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Alexander R. Opotowsky
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Heart Institute, Cincinnati Children’s Hospital, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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22
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Perry T, Lorts A, Morales DLS, Fields K, Fahnhorst SE, Brandewie K, Lubert A, Villa CR. Chronic Ventricular Assist Device Support in Adult Congenital Heart Disease Patients: A Children's Hospital Perspective. ASAIO J 2021; 67:e216-e220. [PMID: 34711747 DOI: 10.1097/mat.0000000000001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With improvement in early surgical outcomes in patients with complex congenital heart disease, most patients are now expected to survive to adulthood. As adult congenital heart disease (ACHD) patients age, they are at risk of heart failure, which has become the leading cause of mortality in ACHD. Some who develop advanced heart failure may not be candidates for transplant, and chronic ventricular assist device (VAD) therapy may be the only means of survival. There is limited experience with chronic VAD therapy in ACHD patients, and the outcomes are not well delineated. We describe our center's experience with chronic VAD therapy in ACHD patients receiving care exclusively within our children's hospital.
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Affiliation(s)
- Tanya Perry
- From the Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Das BB, Kogon B, Deshpande SR, Slaughter MS, Trivedi JR. Contemporary outcomes of durable ventricular assist devices in adults with congenital heart disease as a bridge to heart transplantation. Artif Organs 2021; 46:697-704. [PMID: 34698399 DOI: 10.1111/aor.14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/22/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to compare the clinical characteristics, risk factors, and overall survival outcomes in adults with congenital heart disease (ACHD) bridged to transplantation with a ventricular assist device (VAD) versus no-VAD. METHODS The study included 894 ACHD patients aged ≥18 years listed for primary heart transplantation between 2010 and 2019 from the United Network for Organ Sharing database. Primary outcomes were waitlist and 1-year post-transplant mortality between VAD and no-VAD ACHD patients. RESULTS Of 894 ACHD patients included in the study, 91(10.1%) had VAD support at the time of listing. Patients who needed VAD support were mostly males, heavier, and had higher pulmonary artery pressure than the no-VAD group at the listing. The overall waitlist mortality was 38% in the VAD group than 17% in the no-VAD group (p < 0.01). ECMO use was associated with significantly higher mortality than either group. There was no significant difference in 1-year post-transplant mortality between VAD versus no-VAD at the time of transplant (15% vs. 17%; p = 0.66). Multivariate regression analysis found that BMI <20 kg/m2 (hazard ratio (HR) 1.1; p = 0.01), bilirubin >2 mg/dl (HR 1.1; p = 0.03), creatinine >2 mg/dl (HR 1.3; p = 0.04) and ECMO at transplant (HR 1.4; p = 0.03) increased early post-transplant mortality. CONCLUSIONS The one-year post-transplant mortality rate was no different for ACHD patients that received VAD versus no-VAD. These findings suggest that a VAD should be considered an option to support ACHD patients as a bridge to heart transplantation.
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Affiliation(s)
- Bibhuti B Das
- Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Brian Kogon
- Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Shriprasad R Deshpande
- Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, D.C., USA
| | - Mark S Slaughter
- Division of Cardiovascular Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Jaimin R Trivedi
- Division of Cardiovascular Surgery, University of Louisville, Louisville, Kentucky, USA
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Agarwal A, Gurvitz M, Myers J, Jain S, Khan AM, Nah G, Harris IS, Kouretas P, Marcus GM. Association of Insurance Status With Emergent Versus Nonemergent Hospital Encounters Among Adults With Congenital Heart Disease. J Am Heart Assoc 2021; 10:e021974. [PMID: 34569274 PMCID: PMC8649130 DOI: 10.1161/jaha.121.021974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although the number of hospital visits has exponentially increased for adults with congenital heart disease (CHD) over the past few decades, the relationship between insurance status and hospital encounter type remains unknown. The purpose of this study was to evaluate the association between insurance status and emergent versus nonemergent encounters among adults with CHD ≥18 years old. Methods and Results We used California Office of Statewide Health Planning and Development Database from January 2005 to December 2015 to determine the trends of insurance status and encounters and the association of insurance status on encounter type among adults with CHD. A total 58 359 nonpregnancy encounters were identified in 6077 patients with CHD. From 2005 to 2015, the number of uninsured encounters decreased by 38%, whereas government insured encounters increased by 124% and private by 79%. Overall, there was a significantly higher proportion of emergent than nonemergent encounters associated with uninsured status (13.0% versus 1.8%; P<0.0001), whereas the proportion of nonemergent encounters associated with private insurance was higher than emergent encounters (35.8% versus 62.4%; P<0.0001). When individual patients with CHD became uninsured, they were ≈5 times more likely to experience an emergent encounter (P<0.0001); upon changing from uninsured to insured, they were significantly less likely to have an emergent encounter (P<0.001). After multivariate adjustment, uninsured status exhibited the highest odds of an emergent rather than nonemergent encounter compared with all other covariates (adjusted odds ratio, 9.20; 95% CI, 7.83-10.8; P<0.0001). Conclusions Efforts to enhance the ability to obtain and maintain insurance throughout the lifetime of patients with CHD might result in meaningful reductions in emergent encounters and a more efficient use of resources.
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Affiliation(s)
- Anushree Agarwal
- Division of Cardiology Department of Medicine University of California San Francisco San Francisco CA
| | - Michelle Gurvitz
- Department of Cardiology Boston Adult Congenital Heart ServiceBoston Children's Hospital and Brigham and Women's Hospital Boston MA
| | - Janet Myers
- Division of Prevention Science Department of Medicine University of California San Francisco CA
| | - Sarthak Jain
- Division of Cardiology Department of Medicine University of California San Francisco San Francisco CA
| | - Abigail M Khan
- Adult Congenital Heart Disease Program Knight Cardiovascular InstituteOregon Health & Science University Portland OR
| | - Gregory Nah
- Division of Cardiology Department of Medicine University of California San Francisco San Francisco CA
| | - Ian S Harris
- Division of Cardiology Department of Medicine University of California San Francisco San Francisco CA
| | - Peter Kouretas
- Department of Pediatric Cardiothoracic Surgery University of California San Francisco San Francisco CA
| | - Gregory M Marcus
- Division of Cardiology Department of Medicine University of California San Francisco San Francisco CA
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25
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Fedchenko M, Mandalenakis Z, Giang KW, Rosengren A, Eriksson P, Dellborg M. Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease-a nationwide study. Eur Heart J 2021; 42:2577-2586. [PMID: 33219678 PMCID: PMC8266664 DOI: 10.1093/eurheartj/ehaa874] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/28/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
Aims We aimed to describe the risk of myocardial infarction (MI) in middle-aged and older patients with congenital heart disease (ACHD) and to evaluate the long-term outcomes after index MI in patients with ACHD compared with controls. Methods and results A search of the Swedish National Patient Register identified 17 189 patients with ACHD (52.2% male) and 180 131 age- and sex-matched controls randomly selected from the general population who were born from 1930 to 1970 and were alive at 40 years of age; all followed up until December 2017 (mean follow-up 23.2 ± 11.0 years). Patients with ACHD had a 1.6-fold higher risk of MI compared with controls [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.5–1.7, P < 0.001] and the cumulative incidence of MI by 65 years of age was 7.4% in patients with ACHD vs. 4.4% in controls. Patients with ACHD had a 1.4-fold increased risk of experiencing a composite event after the index MI compared with controls (HR 1.4, 95% CI 1.3–1.6, P < 0.001), driven largely by the occurrence of new-onset heart failure in 42.2% (n = 537) of patients with ACHD vs. 29.5% (n = 2526) of controls. Conclusion Patients with ACHD had an increased risk of developing MI and of recurrent MI, new-onset heart failure, or death after the index MI, compared with controls, mainly because of a higher incidence of newly diagnosed heart failure in patients with ACHD. Recognizing and managing the modifiable cardiovascular risk factors should be of importance to reduce morbidity and mortality in patients with ACHD.
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Affiliation(s)
- Maria Fedchenko
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden.,ACHD Unit, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Kok Wai Giang
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Annika Rosengren
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden.,ACHD Unit, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden.,ACHD Unit, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden
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26
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Khan AM, McGrath LB, Ramsey K, Agarwal A, Broberg CS. Association of Adults With Congenital Heart Disease-Specific Care With Clinical Characteristics and Healthcare Use. J Am Heart Assoc 2021; 10:e019598. [PMID: 34041921 PMCID: PMC8483508 DOI: 10.1161/jaha.120.019598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Many adults with congenital heart disease (ACHD) are cared for by non‐ACHD specialists, if they receive care at all. Little is known about the differences between those who access care at an ACHD center and those who do not access ACHD‐specific care. Methods and Results The Oregon All Payer All Claims database was queried to identify subjects aged 18 to 65 years with an International Classification of Diseases,Ninth Revision (ICD‐9) code consistent with ACHD from 2010 to 2015. ACHD center providers were identified using National Provider Identification numbers. Usage rates and percentages were calculated with person‐years in the denominator, and rate ratios and odds ratios (ORs) were estimated using negative binomial and logistic regression. Only 11.7% of identified individuals (N=10 199) were seen at the ACHD center. These individuals were younger (median 36 versus 47 years; P<0.0001) and had higher rates of Medicaid insurance (47.8% versus 28.4%; P<0.0001), heart failure (31.4% versus 15.3%; P<0.0001), and arrhythmia (75.5 versus 49.2%; P<0.0001). They had more visits of all types (outpatient: 79% per year versus 64% per year [age‐adjusted OR, 2.54; 99% CI, 2.24–2.88]; emergency department: 29% versus 22% per year [adjusted OR, 1.34; 99% CI, 1.18–1.52]; inpatient: 17% versus 12.0% per year [adjusted OR, 1.92; 99% CI, 1.67–2.20]). Rates of guideline‐indicated annual echocardiography were low (7.7% overall, 13.4% in patients at the ACHD center). Conclusions Patients at an ACHD center comprise a distinct and complex group with a high rate of healthcare use and a relatively higher compliance with guideline‐indicated annual follow‐up. These findings underscore the importance of building and supporting robust systems for ACHD care in the United States.
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Affiliation(s)
- Abigail M Khan
- Adult Congenital Heart Disease Program Knight Cardiovascular InstituteOregon Health & Science University Portland OR
| | - Lidija B McGrath
- Adult Congenital Heart Disease Program Knight Cardiovascular InstituteOregon Health & Science University Portland OR
| | - Katrina Ramsey
- Division of Biostatistics and Epidemiology Oregon Health & Science University Portland OR
| | - Anushree Agarwal
- Division of Cardiology Department of Medicine University of California San Francisco CA
| | - Craig S Broberg
- Adult Congenital Heart Disease Program Knight Cardiovascular InstituteOregon Health & Science University Portland OR
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27
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Arnaert S, De Meester P, Troost E, Droogne W, Van Aelst L, Van Cleemput J, Voros G, Gewillig M, Cools B, Moons P, Rega F, Meyns B, Zhang Z, Budts W, Van De Bruaene A. Heart failure related to adult congenital heart disease: prevalence, outcome and risk factors. ESC Heart Fail 2021; 8:2940-2950. [PMID: 33960724 PMCID: PMC8318399 DOI: 10.1002/ehf2.13378] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 01/27/2023] Open
Abstract
Aims Information on the prevalence, outcome and factors associated with heart failure in patients with adult congenital heart disease (CHD) (ACHD‐HF) is lacking. We aimed at assessing the prevalence and outcome of ACHD‐HF, the variables associated with ACHD‐HF, and the differences between major anatomical/pathophysiological ACHD subgroups. Methods and results We included 3905 patients (age 35.4 ± 13.2 years) under active follow‐up in our institution (last visit >2010). Outcome of ACHD‐HF cases was compared with sex‐ and age‐matched cases. Univariable and multivariable binary logistic regression with ACHD‐HF diagnosis as a dependent variable was performed. Overall prevalence of ACHD‐HF was 6.4% (mean age 49.5 ± 16.7 years), but was higher in patients with cyanotic CHD (41%), Fontan circulation (30%), and a systemic right ventricle (25%). All‐cause mortality was higher in ACHD‐HF cases when compared with controls (mortality rate ratio 4.67 (2.36–9.27); P = 0.0001). In multivariable logistic regression analysis, age at latest follow‐up [per 10 years; odds ratio (OR) 1.52; 95% confidence interval (CI) 1.31–1.77], infective endocarditis (OR 4.11; 95%CI 1.80–9.38), history of atrial arrhythmia (OR 3.52; 95%CI 2.17–5.74), pacemaker implantation (OR 2.66; 95% CI 1.50–4.72), end‐organ dysfunction (OR 2.41; 95% CI 1.03–5.63), New York Heart Association class (OR 9.28; 95% CI 6.04–14.25), heart rate (per 10 bpm; OR 1.27; 95% CI 1.08–1.50), ventricular dysfunction (OR 3.62; 95% CI 2.54–5.17), and pulmonary hypertension severity (OR 1.66; 95% CI 1.21–2.30) were independently related to the presence of ACHD‐HF. Some variables (age, atrial arrhythmia, pacemaker, New York Heart Association, and ventricular dysfunction) were related to ACHD‐HF in all anatomical/physiological subgroups, whereas others were not. Conclusions ACHD‐HF is prevalent especially in complex CHD and is associated with poor prognosis. Our data provide insight in the factors related to ACHD‐HF including differences between specific anatomical and physiological subgroups.
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Affiliation(s)
- Stijn Arnaert
- Faculty of Medicine, Department of Internal Medicine, KU Leuven, Leuven, Belgium
| | - Pieter De Meester
- Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Els Troost
- Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Walter Droogne
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Lucas Van Aelst
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Gabor Voros
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Division of Pediatric Cardiology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Bjorn Cools
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Division of Pediatric Cardiology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenborg, Gothenburg, Sweden.,Departments of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Division of cardiac surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Division of cardiac surgery, University Hospitals Leuven, Leuven, Belgium
| | - Zhenyu Zhang
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Leuven, Belgium
| | - Werner Budts
- Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Abstract
The number of rTOF patients who survive into adulthood is steadily rising, with currently more than 90% reaching the third decade of life. However, rTOF patients are not cured, but rather have a lifelong increased risk for cardiac and non-cardiac complications. Heart failure is recognized as a significant complication. Its occurrence is strongly associated with adverse outcome. Unfortunately, conventional concepts of heart failure may not be directly applicable in this patient group. This article presents a review of the current knowledge on HF in rTOF patients, including incidence and prevalence, the most common mechanisms of heart failure, i.e., valvular pathologies, shunt lesions, left atrial hypertension, primary left heart and right heart failure, arrhythmias, and coronary artery disease. In addition, we will review information regarding extracardiac complications, risk factors for the development of heart failure, clinical impact and prognosis, and assessment possibilities, particularly of the right ventricle, as well as management strategies. We explore potential future concepts that may stimulate further research into this field.
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29
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Edelson JB, Rossano JW, Griffis H, Quarshie WO, Ravishankar C, O'Connor MJ, Mascio CE, Mercer-Rosa L, Glatz AC, Lin KY. Resource Use and Outcomes of Pediatric Congenital Heart Disease Admissions: 2003 to 2016. J Am Heart Assoc 2021; 10:e018286. [PMID: 33554612 PMCID: PMC7955343 DOI: 10.1161/jaha.120.018286] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Children with congenital heart disease (CHD) are known to consume a disproportionate share of resources, yet there are limited data concerning trends in resource use and mortality among admitted children with CHD. We hypothesize that charges in CHD‐related admissions increased but that mortality improved over time. Methods and Results This study, including patients <18 years old with CHD, examined inpatient admissions from the nationally representative Kids' Inpatient Database from 2003 to 2016 in order to assess the frequency, medical complexity, and outcomes of CHD hospital admissions. A total of 859 843 admissions of children with CHD were identified. CHD admissions increased by 31.8% from 2003 to 2016, whereas overall pediatric admissions decreased by 13.4%. Compared with non‐CHD admissions, those with CHD were more likely to be <1 year of age (80.5% versus 63.3%), and to have ≥1 complex chronic condition (39.7% versus 9.3%). For CHD admissions, mortality was higher (2.97% versus 0.31%) and adjusted median charges greater ($48 426 [interquartile range (IQR), $11.932–$161 048] versus $4697 [IQR, $2551–$12 301]) (P<0.0001 for all). Among CHD admissions, whereas adjusted median charges increased from $35 577 (IQR, $9303–$110 439) to $61 696 (IQR, $15 212–$219 237), mortality decreased from 3.2% to 2.7% (P for trend <0.0001). CHD admissions accounted for an increased proportion of all inpatient deaths, from 18.0% in 2003 to 24.5% in 2016. Conclusions Children admitted with CHD are 10 times more likely to die than those without CHD and have higher charges. Although the rate of mortality in CHD admissions decreased, children with CHD accounted for an increasing proportion of all pediatric inpatient deaths. Effective resource allocation is critical to optimize outcomes in these high‐risk patients.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA.,Cardiovascular OutcomesQuality and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Joseph W Rossano
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA.,Cardiovascular OutcomesQuality and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Heather Griffis
- Department of Biomedical Health Informatics Healthcare Analytics Unitthe Children's Hospital of Philadelphia PA
| | - William O Quarshie
- Department of Biomedical Health Informatics Healthcare Analytics Unitthe Children's Hospital of Philadelphia PA
| | - Chitra Ravishankar
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Matthew J O'Connor
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Christopher E Mascio
- Division of Cardiothoracic Surgery Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Laura Mercer-Rosa
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Andrew C Glatz
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Kimberly Y Lin
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
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30
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Patel S, Ngai J. Sex Diversity in the Cardiothoracic Anesthesiology Fellowship: The Influence of Geographic Region. J Cardiothorac Vasc Anesth 2021; 35:1725-1731. [PMID: 33573930 DOI: 10.1053/j.jvca.2021.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate if the lack of sex diversity in adult cardiothoracic anesthesiology fellowships is a result of few female applicants or low acceptance rate. DESIGN Retrospective review of adult cardiothoracic anesthesiology applicants and fellows by sex and geographic regions across the United States. SETTING Accreditation Council for Graduate Medical Education's adult cardiothoracic anesthesiology fellowship programs across the United States. PARTICIPANTS Applicants to adult cardiothoracic anesthesiology fellowship programs and fellows. INTERVENTIONS No intervention. MEASUREMENTS AND MAIN RESULTS Numerical comparison of male and female applicants by percentage and acceptance rates into adult cardiothoracic anesthesiology fellowship programs in each geographic region. Women comprised between 27% and 35% of applicants from 2013 to 2018. Acceptance rates for men completing residency in the Midwest region ranged between 67% and 84%, and 67% and 87% for women from the Midwest (p = 0.1-0.9). Men from Northeast residencies had acceptance rate of 71% to 86% and women had rate of 69% to 83% (p = 0.2-0.8). Male and female residents from the Southeast had acceptance rates of 65% to 94% and 71% to 93%, respectively (p = 0.3-0.8). The male residents from the Southwest had acceptance rates of 73% to 85%, and female residents had rates between 44% and 100% (p = 0.02-0.8). The male residents from the West had rates of 59% to 88%, female residents had rates between 64% and 100% (p = 0.1-0.7). CONCLUSIONS There is an absence of clear identification of the barriers preventing women from entering cardiac anesthesiology. The reasons leading to a male-dominated field of cardiac anesthesiologists stem from fewer female anesthesiology residents applying to cardiothoracic anesthesiology fellowships. No bias against acceptance of women into cardiothoracic anesthesiology fellowships was found.
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Affiliation(s)
- Shayna Patel
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, NY; Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Jennie Ngai
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, NY.
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31
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Burstein DS, Rossano JW, Griffis H, Zhang X, Fowler R, Frischertz B, Kim YY, Lindenfield J, Mazurek JA, Edelson JB, Menachem JN. Greater admissions, mortality and cost of heart failure in adults with congenital heart disease. Heart 2020; 107:807-813. [PMID: 33361349 DOI: 10.1136/heartjnl-2020-318246] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Limited contemporary data exist regarding outcomes and resource use among adults with congenital heart disease and heart failure (ACHD-HF). This study compared outcomes, emergency department (ED) and hospital resource use, and advanced heart failure (HF) therapies in ACHD-HF versus non-ACHD with HF (HF-non-ACHD). METHODS The Nationwide Emergency Department Sample and Nationwide Inpatient Sample were used to analyse outcomes and resource use among ACHD-HF ED visits and hospitalisations from 2006 to 2016. ACHD-HF was stratified by single-ventricle (SV) and two-ventricle (2V) disease. RESULTS A total of 76 557 ACHD-HF visits (3.6% SV physiology) and 31 137 414 HF-non-ACHD visits were analysed. ACHD-HFs were younger (SV 33 years (IQR 25-44), 2V 62 years (IQR 45-76); HF-non-ACHD 74 years (IQR 63-83); p<0.001). ACHD-HFs had higher ED admissions (78% vs 70%, p<0.001), longer hospital length of stay (5 days (IQR 2-8) vs 4 days (IQR 2-7), p<0.001) and greater hospital costs ($49K (IQR 2K-121K) vs $32K (17K-66K), p<0.001). Mortality was significantly higher among ACHD-HFs with SV physiology (6.6%; OR 1.6, 95% CI 1.1 to 2.3) or 2V physiology (6.3%; OR 1.4, 95% CI 1.3 to 1.5) versus HF-non-ACHD (5.5%). ACHF-HF hospitalisations increased more (46% vs 6% HF-non-ACHD) over a 10-year period, but the proportion receiving ventricular assist device (VAD) (ACHD-HF -2% vs HF-non-ACHD 294%) or transplant (ACHD-HF -37% vs HF-non-ACHD 73%) decreased. CONCLUSION ACHD-HFs have significant ED and hospital resource use that has increased over the past 10 years. However, advanced HF therapies (VAD and transplantation) are less commonly used compared with those without adult congenital heart disease.
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Affiliation(s)
- Danielle S Burstein
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph W Rossano
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Griffis
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Xuemei Zhang
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rachel Fowler
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Frischertz
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuli Y Kim
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - JoAnn Lindenfield
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeremy A Mazurek
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan B Edelson
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jonathan N Menachem
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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32
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Ntiloudi D, Dimopoulos K, Tzifa A, Karvounis H, Giannakoulas G. Hospitalizations in adult patients with congenital heart disease: an emerging challenge. Heart Fail Rev 2020; 26:347-353. [PMID: 32914242 DOI: 10.1007/s10741-020-10026-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
The vast majority of patients with congenital heart disease (CHD) survive into adulthood, but many face lifelong complications, which often result in a hospital admission. The increasing number of hospitalizations in adults with CHD (ACHD) poses a significant challenge for healthcare systems globally, especially as heart failure (HF) is becoming increasingly common in this population and is the leading cause of morbidity and mortality. Besides HF, other major contributors to this increase in admission volume are hospitalizations related to mild lesions, comorbidities and pregnancies. Ιn-hospital mortality ranges between 0.8 and 6.1%, while hospitalizations related to HF predict medium-term mortality in ACHD population. Understanding the predictors of hospitalization and in-hospital mortality is, therefore, important for ACHD healthcare providers, who should identify patients at risk that require escalation of treatment and/or close monitoring. This article reviews the available literature on hospitalization patterns in ACHD patients, with a focus on HF-related hospital admissions and specific diagnostic subgroups.
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Affiliation(s)
- Despoina Ntiloudi
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kyriakidi str 1, 546 36, Thessaloniki, Greece
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Aphrodite Tzifa
- Department of Congenital Cardiology and Cardiac Surgery, Mitera Hospital, Athens, Greece.,Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Haralambos Karvounis
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kyriakidi str 1, 546 36, Thessaloniki, Greece
| | - George Giannakoulas
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kyriakidi str 1, 546 36, Thessaloniki, Greece.
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Leusveld EM, Kauling RM, Geenen LW, Roos-Hesselink JW. Heart failure in congenital heart disease: management options and clinical challenges. Expert Rev Cardiovasc Ther 2020; 18:503-516. [DOI: 10.1080/14779072.2020.1797488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Elsbeth M. Leusveld
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert M. Kauling
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Laurie W. Geenen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Saarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Factors affecting adolescents' participation in randomized controlled trials evaluating the effectiveness of healthcare interventions: the case of the STEPSTONES project. BMC Med Res Methodol 2020; 20:205. [PMID: 32746862 PMCID: PMC7398069 DOI: 10.1186/s12874-020-01088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/27/2020] [Indexed: 01/10/2023] Open
Abstract
Background Recruitment of adolescents to intervention studies is a known challenge. For randomized controlled trials (RCT) to be generalizable, reach must be assessed, which means ascertaining how many of the intended population actually participated in the trial. The aim of this study was to evaluate the reach and representativeness of an RCT evaluating the effectiveness of a complex intervention for adolescents with chronic conditions. Methods A mixed methods sequential explanatory design was employed. Firstly, quantitative cross-sectional data from the RCT, patient registries and medical records were collected and analysed regarding baseline differences between participants and non-participants in the trial. Secondly, qualitative data on their reasons for participating or not were collected and analysed with content analysis to explain the quantitative findings. Results Participants showed larger differences in effect sizes and a significantly more complex chronic condition than non-participants. No other statistically significant differences were reported, and effect sizes were negligible. Reasons for declining or accepting participation were categorized into three main categories: altruistic reasons, personal reasons and external reasons and factors. Conclusions Integration of quantitative and qualitative findings showed that participation in the RCT was affected by disease complexity, the perceived need to give back to healthcare and research and the adolescents’ willingness to engage in their illness. To empower adolescents with chronic conditions and motivate them to participate in research, future intervention studies should consider developing tailored recruitment strategies and communications with sub-groups that are harder to reach.
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Affiliation(s)
- Markus Saarijärvi
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Lars Wallin
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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35
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Thangappan K, Morales DLS, Vu Q, Lehenbauer D, Villa C, Wittekind S, Hirsch R, Lorts A, Zafar F. Impact of mechanical circulatory support on pediatric heart transplant candidates with elevated pulmonary vascular resistance. Artif Organs 2020; 45:29-37. [PMID: 32530089 DOI: 10.1111/aor.13747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/28/2020] [Accepted: 05/30/2020] [Indexed: 12/31/2022]
Abstract
With the new era of increasing use of mechanical circulatory support (MCS) in children, seemingly more patients with elevated pulmonary vascular resistance (PVR) are having positive outcomes. The purpose of this study was to define the effect of MCS on pediatric patients listed for heart transplant with an elevated PVR. The United Network for Organ Sharing (UNOS) database was used to identify patients aged 0-18 at the time of listing for heart transplant between 2010 and 2019 who had PVR documented (n = 2081). Patients were divided into MCS (LVAD, RVAD, BiVAD, and TAH) and No MCS groups, then divided by PVR (PVR) at the time of listing: <3, 3-6, and >6 Wood units (WU). MCS was used in 20% overall (n = 426); 57% of those with PVR <3, 27% with PVR 3-6, and 16% with PVR >6. MCS, PVR <3 patients had a higher chance of positive waitlist outcome than all No MCS groups (vs. PVR <3, P = .049; vs. PVR 3-6, P = .004; vs. PVR >6, P < .001). MCS, PVR 3-6 patients had a higher chance of positive waitlist outcome than all No MCS groups (vs. PVR <3, P = .048; vs. PVR 3-6, P = .009; vs. PVR >6, P < .001). MCS, PVR >6 patients had a higher chance of positive waitlist outcome than No MCS, PVR >6 patients (P = .012). Within the No MCS group, patients with a PVR >6 had a higher incidence of negative waitlist outcome compared to PVR <3 (17% vs. 10%, P = .002); this was not the case in the MCS group (5% vs. 6%, P = .693). More patients in the MCS group were ventilator dependent (15% vs. 9%, P < .001) at the time of listing and less likely to have a functional status >50% (43% vs. 73%, P < .001). No significant differences in post-transplant survival were found in pairwise comparisons of MCS and No MCS PVR subgroups. Patients supported with MCS had a significantly higher chance of a positive waitlist outcome than those without such support regardless of PVR status. This was most pronounced with a PVR greater than 6 WU. MCS compared to No MCS patients had better waitlist survival and equivalent post-transplant survival. MCS patients, despite being more ill, had better overall survival regardless of PVR.
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Affiliation(s)
- Karthik Thangappan
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David L S Morales
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Quyen Vu
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David Lehenbauer
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chet Villa
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Samuel Wittekind
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Russel Hirsch
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Angela Lorts
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Farhan Zafar
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Wang F, Liu A, Brophy JM, Cohen S, Abrahamowicz M, Paradis G, Marelli A. Determinants of Survival in Older Adults With Congenital Heart Disease Newly Hospitalized for Heart Failure. Circ Heart Fail 2020; 13:e006490. [PMID: 32673500 DOI: 10.1161/circheartfailure.119.006490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nearly 90% of patients with adult congenital heart disease (ACHD) die after the age of 40 years, and heart failure (HF) is the most common cause of death. We aimed to characterize the association between an incident HF hospitalization (HFH) and mortality and to identify the predictors of 1-year postdischarge mortality after incident and repeated HFHs, respectively. METHODS Patients with ACHD aged ≥40 years between 2000 and 2010 were identified from the Québec CHD database. We conducted a propensity score-matched study to explore the association between an incident HFH and mortality. We performed Bayesian model averaging to identify the predictors of 1-year postdischarge mortality with a posterior probability ≥50% considered to be evidence of a significant association. RESULTS The mortality hazard ratio was high at 6.01 (95% CI, 4.02-10.72) within 1-year postdischarge, decreasing significantly but entering an elevated equilibrium until year 4 with a continued 3-fold increase in death. Kidney dysfunction (hazard ratio, 2.28 [95% credible interval, 1.59-3.28], posterior probability, 100.0%) and a history of ≥2 HFHs in the past 12 months (hazard ratio, 1.77 [95% credible interval, 1.18-2.66], posterior probability: 82.2%) were the most robust predictors of 1-year mortality after incident and repeated HFHs, respectively. CONCLUSIONS In patients with ACHD aged ≥40 years, incident HFH was associated with high mortality risk at 1 year, declining but remaining elevated for 4 years. Kidney dysfunction was a potent predictor of 1-year mortality risk after incident HFHs. Repeated HFHs further increased mortality risk. These observations should inform early risk-tailored health services interventions for monitoring and prevention of HF and its associated complications in older patients with ACHD.
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Affiliation(s)
- Fei Wang
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.).,McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, QC, Canada (F.W., A.L., A.M.)
| | - Aihua Liu
- McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, QC, Canada (F.W., A.L., A.M.)
| | - James M Brophy
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.).,Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (J.M.B.)
| | - Sarah Cohen
- Hospital Marie Lannelongue, Congenital Heart Diseases Department, Complex Congenital Heart Diseases M3C Network, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France (S.C.)
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.)
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.)
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, QC, Canada (F.W., A.L., A.M.)
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37
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Monaco J, Khanna A, Khazanie P. Transplant and mechanical circulatory support in patients with adult congenital heart disease. Heart Fail Rev 2020; 25:671-683. [PMID: 32472522 PMCID: PMC7811764 DOI: 10.1007/s10741-020-09976-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Advances in surgery and pediatric care over the past decades have achieved improved survival for children born with congenital heart disease (CHD) and have produced a large, growing population of patients with adult congenital heart disease (ACHD). Heart failure has emerged as the leading cause of death and a major cause of morbidity among the ACHD population, while as little evidence supports the efficacy of guideline-directed medical therapies in this population. It is increasingly important that clinicians caring for these patients understand how to utilize mechanical circulatory support (MCS) in ACHD. In this review, we summarize the data on transplantation and MCS in the ACHD-heart failure population and provide a framework for how ACHD patients may benefit from advanced heart failure therapies like transplantation and MCS.
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Affiliation(s)
- James Monaco
- Colorado University Hospital, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
| | - Amber Khanna
- Colorado University Hospital, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Prateeti Khazanie
- Colorado University Hospital, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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Abstract
BACKGROUND The incidence of heart failure is increasing within the Fontan population. The use of serological markers, including B-type natriuretic peptide, has been limited in this patient population. METHODS This was a single-centre retrospective study of Fontan patients in acute decompensated heart failure. Fontan patients underwent a 1:2 match with non-Fontan patients for each heart failure hospitalisation for comparative analysis. A univariate logistic regression model was used to assess associations between laboratory and echocardiographic markers and a prolonged length of stay of 7 days or greater. RESULTS B-type natriuretic peptide levels were significantly lower in Fontan patients admitted for heart failure than that in non-Fontan patients [390.9 (±378.7) pg/ml versus 1245.6 (±1160.7) pg/ml, respectively, p < 0.0001] and were higher in Fontan patients with systemic ventricular systolic or diastolic dysfunction than that in Fontan patients with normal systemic ventricular function [833.6 (±1547.2) pg/ml versus 138.6 (±134.0) pg/ml, p = 0.017]. The change from the last known outpatient value was smaller in Fontan patients in comparison with non-Fontan patients [65.7 (±185.7) pg/ml versus 1638.0 (±1444.7) pg/ml, respectively, p < 0.0001]. Low haemoglobin and high blood urea nitrogen levels were associated with a prolonged length of stay. CONCLUSION B-type natriuretic peptide levels do not accurately reflect decompensated heart failure in Fontan patients when compared to non-Fontan heart failure patients and should, therefore, be used with caution in this patient population.
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39
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Desai R, Patel K, Dave H, Shah K, DeWitt N, Fong HK, Varma Y, Varma K, Mansuri Z, Sachdeva R, Khanna A, Kumar G. Nationwide Frequency, Sequential Trends, and Impact of Co-morbid Mental Health Disorders on Hospitalizations, Outcomes, and Healthcare Resource Utilization in Adult Congenital Heart Disease. Am J Cardiol 2020; 125:1256-1262. [PMID: 32085866 DOI: 10.1016/j.amjcard.2020.01.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 12/28/2022]
Abstract
Despite the growing prevalence of adult congenital heart disease (ACHD), data on trends in prevalence of mental health disorders (MHD) among patients with ACHD remain limited. The National Inpatient Sample (2007 to 2014) was queried to identify the frequency and trends of MHD among ACHD hospitalizations (stratification by age, sex, and race); demographics and co-morbidities for ACHD cohorts, with (MHD+) versus without MHD (MHD-); the rate and trends of all-cause in-hospital mortality, disposition, mean length of stay, and hospitalization charges among both cohorts. A total of 11,709 (13.8%, mean age: 49.1 years, 56.0% females, 78.7% white) out of 85,029 ACHD patient encounters had a coexistent MHD (anxiety, depression, mood disorder, or psychosis). ACHD-MHD+ cohort was more often admitted nonelectively (38.1% vs 32.8%, p <0.001) and had a higher frequency of cardiac/extra-cardiac co-morbidities. The trends in prevalence of coexistent MHD increased from 10.3% to 17.5% (70% relative increase) from 2007 to 2014 with a consistently higher prevalence among females (from 13% to 20.3%) compared to males (from 7.6% to 15.5%) (ptrend <0.001). The hospitalization trends with MHD increased in whites (12.1% to 19.8%) and Hispanics (5.9% to 12.7%). All-cause mortality was lower (0.7% vs 1.1%, p = 0.002) in ACHD-MHD+; however, mean length of stay (∼5.7 vs 4.9 days, p <0.001) was higher without significant difference in charges ($97,710 vs $96,058, p = 0.137). ACHD-MHD+ cohort was less often discharged routinely (declining trend) and more frequently transferred to other facilities and required home healthcare (rising trends). In conclusion, this study reveals increasing trends of MHD, healthcare resource utilization and a higher frequency of co-morbidities in patients with ACHD.
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40
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Thangappan K, Ashfaq A, Villa C, Morales DLS. The total artificial heart in patients with congenital heart disease. Ann Cardiothorac Surg 2020; 9:89-97. [PMID: 32309156 DOI: 10.21037/acs.2020.02.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background While ventricular assist devices (VADs) remain the cornerstone of mechanical circulatory support (MCS), the total artificial heart (TAH-t) has gained popularity for certain patients in whom VAD support is not ideal. Congenital heart disease (CHD) patients often have barriers to VAD placement due to anatomic and physiological variation and thus can benefit from the TAH-t. The purpose of this study is to analyze the differences in TAH application and outcomes in patients with and without CHD. Methods The SynCardia Department of Clinical Research provided data upon request for all TAH-t implantations worldwide from December 1985 to October 2019. These patients were divided into two groups by pre-implantation diagnosis of CHD and non-CHD. Results A total of 1,876 patients were identified. Eighty (4%) of these patients also carried a diagnosis of CHD. There was a higher proportion of children in the CHD cohort (16.3% vs. 2.1%, P<0.001) and this translated into a lower average age amongst the two groups (34±13 vs. 49±13 years, P<0.001). There were also significantly more females in the CHD group (22.8% vs. 12.8%, P=0.010). CHD patients were more likely to be supported with a 50 cc TAH-t (11.3% vs. 4.5%, P=0.005) while all other support characteristics, including duration of support, were similar between the groups. All measured outcomes were similar between CHD and non-CHD patients including positive outcome (alive on device or transplanted), 1-month conditional survival, and rate of Freedom Driver use. Conclusions TAH-t is an effective means to support patients with CHD. Patients with CHD had similar survival, support characteristics, and frequency of discharge compared to patients without CHD. As MCS continues to grow, its indications broadened, and its contraindications narrowed, more patient populations will see the benefit of the TAH's continuously developing technology.
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Affiliation(s)
- Karthik Thangappan
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Awais Ashfaq
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Chet Villa
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David L S Morales
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Gallego P, Oliver JM. Medical therapy for heart failure in adult congenital heart disease: does it work? Heart 2019; 106:154-162. [DOI: 10.1136/heartjnl-2019-314701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Agarwal A, Thombley R, Broberg CS, Harris IS, Foster E, Mahadevan VS, John A, Vittinghoff E, Marcus GM, Dudley RA. Age- and Lesion-Related Comorbidity Burden Among US Adults With Congenital Heart Disease: A Population-Based Study. J Am Heart Assoc 2019; 8:e013450. [PMID: 31575318 PMCID: PMC6818026 DOI: 10.1161/jaha.119.013450] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background As patients with congenital heart disease (CHD) are living longer, understanding the comorbidities they develop as they age is increasingly important. However, there are no published population-based estimates of the comorbidity burden among the US adult patients with CHD. Methods and Results Using the IBM MarketScan commercial claims database from 2010 to 2016, we identified adults aged ≥18 years with CHD and 2 full years of continuous enrollment. These were frequency matched with adults without CHD within categories jointly defined by age, sex, and dates of enrollment in the database. A total of 40 127 patients with CHD met the inclusion criteria (mean [SD] age, 36.8 [14.6] years; and 48.2% were women). Adults with CHD were nearly twice as likely to have any comorbidity than those without CHD (P<0.001). After adjusting for covariates, patients with CHD had a higher prevalence risk ratio for "previously recognized to be common in CHD" (risk ratio, 9.41; 95% CI, 7.99-11.1), "other cardiovascular" (risk ratio, 1.73; 95% CI, 1.66-1.80), and "noncardiovascular" (risk ratio, 1.47; 95% CI, 1.41-1.52) comorbidities. After adjusting for covariates and considering interaction with age, patients with severe CHD had higher risks of previously recognized to be common in CHD and lower risks of other cardiovascular comorbidities than age-stratified patients with nonsevere CHD. For noncardiovascular comorbidities, the risk was higher among patients with severe than nonsevere CHD before, but not after, the age of 40 years. Conclusions Our data underscore the unique clinical needs of adults with CHD compared with their peers. Clinicians caring for CHD may want to use a multidisciplinary approach, including building close collaborations with internists and specialists, to help provide appropriate care for the highly prevalent noncardiovascular comorbidities.
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Affiliation(s)
- Anushree Agarwal
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Robert Thombley
- Department of Medicine Philip R. Lee Institute for Health Policy Studies School of Medicine, and Center for Healthcare Value University of California, San Francisco San Francisco CA
| | - Craig S Broberg
- Adult Congenital Heart Disease Program Knight Cardiovascular Institute Oregon Health and Science University Portland OR
| | - Ian S Harris
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Elyse Foster
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Vaikom S Mahadevan
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Anitha John
- Division of Cardiology Children's National Health System Washington DC
| | - Eric Vittinghoff
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Greg M Marcus
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - R Adams Dudley
- Department of Medicine Philip R. Lee Institute for Health Policy Studies School of Medicine, and Center for Healthcare Value University of California, San Francisco San Francisco CA
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Agarwal A, Dudley CW, Nah G, Hayward R, Tseng ZH. Clinical Outcomes During Admissions for Heart Failure Among Adults With Congenital Heart Disease. J Am Heart Assoc 2019; 8:e012595. [PMID: 31423885 PMCID: PMC6759911 DOI: 10.1161/jaha.119.012595] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Heart failure (HF) admissions in adults with congenital heart disease (CHD) are becoming more common. We compared in‐hospital and readmission events among adults with and without CHD admitted for HF. Methods and Results We identified all admissions with the primary diagnosis of HF among adults in the California State Inpatient Database between January 1, 2005 and January 1, 2012. International Classification of Disease (ICD) codes identified the type of CHD lesion, comorbidities, and in‐hospital and 30‐day readmissions events. Adjusted odds ratio (AOR, 95% CI) was calculated after adjusting for admission year, age, sex, race, household income, primary payor, and Charlson comorbidity index. Of 203 759 patients admitted for HF, 539 had CHD other than atrial septal defect. Compared with patients admitted for HF without CHD, those with CHD were younger, more often male, and had fewer comorbidities as determined by Charlson comorbidity index. On multivariate analysis, CHD patients admitted for HF had higher odds of length of stay ≥7 days (AOR 2.5 [95% CI 2.0–3.1]), incident arrhythmias (AOR 2.8 [95% CI 1.7–4.5]), and in‐hospital mortality (AOR 1.9 [95% CI 1.1–3.1]). Also, CHD patients had lower odds of readmission for HF (AOR 0.6 [95% CI 0.3–0.9]), but similar odds of other 30‐day readmission events. Complex CHD patients had higher odds of length of stay ≥7 days (AOR 1.9 [95% CI 1.1–3.3]) than patients with noncomplex CHD lesions, but similar odds of all other clinical outcomes. Conclusions Among patients admitted with the primary diagnosis of HF in California, adults with CHD have substantially higher odds of longer length of stay, incident arrhythmias, and in‐hospital mortality compared with non‐CHD patients. These results suggest a need for HF risk stratification strategies and management protocols specific for patients with CHD.
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Affiliation(s)
- Anushree Agarwal
- Division of Cardiology Department of Medicine University of California San Francisco San Francisco CA
| | - Carson W Dudley
- Division of Cardiology Department of Medicine University of California San Francisco San Francisco CA
| | - Gregory Nah
- Division of Cardiology Department of Medicine University of California San Francisco San Francisco CA
| | - Robert Hayward
- Electrophysiology Section Division of Cardiology Department of Medicine University of Massachusetts Health Care Worcester Massachusetts
| | - Zian H Tseng
- Electrophysiology Section Division of Cardiology Department of Medicine University of California San Francisco San Francisco CA
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Goeddel LA, Jung YH, Patel P, Upchurch P, Fernando RJ, Ramakrishna H. Analysis of the 2018 American Heart Association/American College of Cardiology Guidelines for the Management of Adults With Congenital Heart Disease: Implications for the Cardiovascular Anesthesiologist. J Cardiothorac Vasc Anesth 2019; 34:1348-1365. [PMID: 31494006 DOI: 10.1053/j.jvca.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Lee A Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Youn Hoa Jung
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Prakash Patel
- Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Patrick Upchurch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rohesh J Fernando
- Division of Cardiothoracic Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Salciccioli KB, Oluyomi A, Lupo PJ, Ermis PR, Lopez KN. A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease. CONGENIT HEART DIS 2019; 14:752-759. [PMID: 31361081 DOI: 10.1111/chd.12819] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Follow-up at a regional adult congenital heart disease (ACHD) center is recommended for all ACHD patients at least once per the 2018 ACC/AHA guidelines. Other specialties have demonstrated poorer follow-up and outcomes correlating with increased distance from health care providers, but driving time to regional ACHD centers has not been examined in the US population. OBJECTIVE To identify and characterize potential disparities in access to ACHD care in the US based on drive time to ACHD centers and compounding sociodemographic factors. METHODS Mid- to high-volume ACHD centers with ≥500 outpatient ACHD visits and ≥20 ACHD surgeries annually were included based on self-reported, public data. Geographic Information System mapping was used to delineate drive times to ACHD centers. Sociodemographic data from the 2012-2016 American Community Survey (US Census) and the Environmental Systems Research Institute were analyzed based on drive time to nearest ACHD center. Previously established CHD prevalence estimates were used to estimate the similarly located US ACHD population. RESULTS Nearly half of the continental US population (45.1%) lives >1 hour drive to an ACHD center. Overall, 39.7% live 1-4 hours away, 3.4% live 4-6 hours away, and 2.0% live >6 hours away. Hispanics were disproportionately likely to live a >6 hour drive to a center (p < .001). Compared to people with <1 hour drive, those living >6 hours away have higher proportions of uninsured adults (29% vs. 18%; p < .001), households below the federal poverty level (19% vs. 13%; p < .001), and adults with less than college education (18% vs. 12%; p < .001). CONCLUSIONS We estimate that ~45% of the continental US population lives >1 hour to an ACHD center, with 5.4% living >4 hours away. Compounding barriers exist for Hispanic, uninsured, lower socioeconomic status, and less-educated patients. These results may help drive future policy changes to improve access to ACHD care.
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Affiliation(s)
- Katherine B Salciccioli
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Abiodun Oluyomi
- Environmental Health Service, Section of General Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Philip J Lupo
- Section of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Peter R Ermis
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Keila N Lopez
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Wang F, Harel-Sterling L, Cohen S, Liu A, Brophy JM, Paradis G, Marelli AJ. Heart failure risk predictions in adult patients with congenital heart disease: a systematic review. Heart 2019; 105:1661-1669. [DOI: 10.1136/heartjnl-2019-314977] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/15/2019] [Accepted: 06/21/2019] [Indexed: 01/05/2023] Open
Abstract
To summarise existing heart failure (HF) risk prediction models and describe the risk factors for HF-related adverse outcomes in adult patients with congenital heart disease (CHD). We performed a systematic search of MEDLINE, EMBASE and Cochrane databases from January 1996 to December 2018. Studies were eligible if they developed multivariable models for risk prediction of decompensated HF in adult patients with CHD (ACHD), death in patients with ACHD-HF or both, or if they reported corresponding predictors. A standardised form was used to extract information from selected studies. Twenty-five studies met the inclusion criteria and all studies were at moderate to high risk of bias. One study derived a model to predict the risk of a composite outcome (HF, death or arrhythmia) with a c-statistic of 0.85. Two studies applied an existing general HF model to patients with ACHD but did not report model performance. Twenty studies presented predictors of decompensated HF, and four examined patient characteristics associated with mortality (two reported predictors of both). A wide variation in population characteristics, outcome of interest and candidate risk factors was observed between studies. Although there were substantial inconsistencies regarding which patient characteristics were predictive of HF-related adverse outcomes, brain natriuretic peptide, New York Heart Association class and CHD lesion characteristics were shown to be important predictors. To date, evidence in the published literature is insufficient to accurately profile patients with ACHD. High-quality studies are required to develop a unique ACHD-HF prediction model and confirm the predictive roles of potential risk factors.
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Chan J, Collins RT, Hall M, John A. Resource Utilization Among Adult Congenital Heart Failure Admissions in Pediatric Hospitals. Am J Cardiol 2019; 123:839-846. [PMID: 30579512 DOI: 10.1016/j.amjcard.2018.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
We sought to analyze the trends and resource utilization of adult congenital heart disease (ACHD)-related heart failure admissions at children's hospitals. Heart failure admissions in patients with ACHD continue to rise at both pediatric and adult care facilities. Data from the Pediatric Health Information Systems database (2005 to 2015) were used to identify patients (≥18 years) admitted with congenital heart disease (745.xx-747.xx) and principal diagnosis of heart failure (428.xx). High resource use (HRU) admissions were defined as those over the 90th percentile. There were 562 admissions (55.9% male) across 39 pediatric hospitals. ACHD-related heart failure admissions increased from 4.1% in 2006 to 6.3% in 2015 (p = 0.015). Median hospital charge for ACHD-related heart failure admissions was $59,055 [IQR $26,633 to $156,846]. Total charges increased with more complex anatomic category (p = 0.049). Though HRU admissions represented 10% of ACHD-related heart failure admissions, they accounted for >66% of the total charges. The median total hospital charges for HRU admissions were $1,018,656 [IQR $722,574 to $1,784,743], compared with $58,890 [IQR $26,456 to $145,890] for non-HRU admissions (p < 0.001). Inpatient mortality rate (26.3% vs 4.0%) and the presence of ≥2 comorbidities (68% vs 31%) were higher for HRU admissions (p < 0.001). On multivariable analysis, technology dependence (aOR: 4.4, p < 0.001) and renal comorbidities (aOR: 3.0, p = 0.04) were associated with HRU. In conclusion, heart failure-related ACHD admissions in pediatric hospitals are increasing. Compared with non-HRU, HRU admissions had higher inhospital mortality and greater comorbidities. Additional care strategies to reduce resource use among these patients and improve overall quality of care merits further study.
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Broda CR. Opportunities for training to advance the care for adults with congenital heart disease with advanced circulatory failure. CONGENIT HEART DIS 2019; 14:487-490. [PMID: 30681778 DOI: 10.1111/chd.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
Abstract
Heart failure is an emerging issue with important implications in adult patients with congenital heart disease. Practitioners with expertise in both adult congenital heart disease and heart failure are needed to manage this growing and often complex population. In the United States, the optimal training pathway to enable practitioners to best care for these patients is ill-defined. This article explores possibilities and issues that interested trainees may encounter during their training experience.
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Affiliation(s)
- Christopher R Broda
- Department of Pediatrics, Section of Pediatric and Adult Congenital Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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