Abstract 18314: Adult Congenital Heart Failure Admissions in the United States: Trends, Resource Utilization & Mortality
Objectives: The primary objective of this study was to characterize temporal trends, health resource utilization, and outcomes in heart failure (HF) hospitalizations among adults with congenital heart disease.
Background: Understanding HF hospitalization patterns and resource needs among adult congenital heart disease (ACHD) patients is necessary to address the future care needs of this rapidly expanding population.
Methods: The Nationwide Inpatient Sample (NIS) is a stratified sample designed to approximate a 20% sample of US community hospitals; sampling weights are used to produce a national sample. Using the NIS we compared trends in ACHD related HF hospitalizations versus non-congenital HF admissions between 1998 and 2011. Trends during the study period were evaluated using the Mann-Kendall trend test. ACHD-related HF hospitalization outcomes were assessed including mortality and high resource utilization (HRU) admissions. Multivariable logistic regression was used to examine factors influencing mortality following HF hospitalization.
Results: During the study period, ACHD-related HF hospitalizations increased from 4620 to 8809 constituting a 91% rise (p<0.0001). HF as a primary diagnosis increased 47% in ACHD patients (p=0.001) whereas HF as a primary diagnosis in non-ACHD patients was unchanged (p=0.58). The distribution of HF hospitalizations remained stable across all ACHD age groups. Whereas high volume ACHD centers accounted for 10% of adult hospitals they managed 53% of ACHD HF admissions. Hospitalization in a high volume center was associated with lower mortality (OR 0.86 CI 0.75-0.99, p = 0.03). ACHD HF patients had longer inpatient stays with criteria for HRU being met in 21% of ACHD-related HF hospitalizations vs. 10% of others (p<0.001).
Conclusions: We report a stark rise in hospitalizations and costs associated with ACHD-related HF over the last decade. The lower mortality during HF hospitalizations in high volume ACHD centers suggests that the availability of ACHD HF expertise may improve HF outcomes.
Author Disclosures: L.J. Burchill: None. L. Gao: None. J. Minnier: None. A.H. Kovacs: None. A.M. Khan: None. A. Opotowsky: None. C.S. Broberg: None. B.G. Maxwell: None.
- © 2016 by American Heart Association, Inc.