Abstract 11608: Risk Factors for Atrial Arrhythmia and Thromboembolic Events in D-Transposition of the Great Arteries
Introduction: Atrial arrhythmia (AA) is an important problem in patients with adult congenital heart disease (ACHD). Relatively little is known about the prevalence and risk factors for thromboembolic events (TE) in patients with D-TGA and AA and further prospective study on this subpopulation of ACHD patients is difficult. Therefore, we sought to define the prevalence of AA and TE in a large, national sample of patients with D-transposition of the great arteries (D-TGA).
Methods: Retrospective analysis of health insurance claims data for a national sample of privately insured patients over the years 2008-2011. Individuals were included in the study cohort if they had a claim submitted for D-TGA at any time over the study period. The primary endpoints were claims submitted for AA, TE, and bleeding events; multivariate logistic regression was performed to identify independent variables associated with AA and TE.
Results: 3,414 patients were included in the final cohort, 253 (7.4%) had an AA, 38 (1.1%) had a TE, and 18 (0.5%) experienced a major bleeding event. The average age of patients with AA was 30.1 years compared to 15.6 years for those without AA. Independent variables associated with AA were age (OR 1.1, 95% CI:1.05-1.07), hypertension (HTN; OR 3.86, 95% CI:2.87-5.18), and hospitalization for congestive heart failure (CHF; OR 4.8, 95% CI:2.49-9.18). Those associated with TE were age (OR 1.06, 95% CI:1.04-1.09), and hospitalization for CHF (OR 5.87, 95% CI:2.01-16.58). AA was not associated with TE (OR 0.95, 95% CI:0.39-2.34).
Conclusions: AA is common in the D-TGA patient; AA is more common in the adult patient than in the pediatric patient. Heart failure is strongly associated with AA and TE; AA alone is not associated with TE. Bleeding events are not prevalent in this population. Despite use in CHADS-VASc for risk stratification of TE in adults with acquired heart disease, sex, diabetes, and HTN are not significantly associated with TE. These data further highlight important clinical differences and management strategies between pediatric, adult congenital heart disease and adult acquired heart disease patients.
Author Disclosures: A. Foy: None. G. Liu: None. W.R. Davidson: None. D. Leslie: None. J.G. Ting: None.
- © 2014 by American Heart Association, Inc.