Abstract 20368: Congestive Heart failure in Adults With Congenital Heart Diseases: What Predicts it and How Does it Affect Mortality?
Introduction: Adults with congenital heart disease (ACHD) are not cured and residual disease predispose them to congestive heart failure (CHF). This study aimed to calculate the cumulative probability of CHF, identify predictors of one-year risk of CHF and assess the impact of CHF on mortality.
Methods: A retrospective cohort of 27975 was constructed consisting of patients from the Quebec Congenital heart disease (CHD) database aged 18-65 between 1995 and 2010. We calculated the cumulative probability of CHF hospitalization using the Practical Incidence Estimator macro adjusting for the competing risk of death. We conducted regression analyses to identify the predictors of one-year risk of CHF hospitalization. To assess the impact of CHF hospitalization on mortality, we used propensity score matching (age, sex, CHD lesion, hypertension, arrhythmia, diabetes, coronary artery disease, chronic kidney disease, endocarditis, and cardiac surgery) to select random controls for each CHF hospitalized patient.
Results: The cumulative probability of CHF hospitalization by age 65 was 33.2%. Age, sex, CHD severity, CHF hospitalization history and comorbidities including arrhythmia, pulmonary hypertension, and coronary heart disease in the previous 12 months were predictive of one-year CHF hospitalization. CHF hospitality is associated with 5 fold increase in mortality risk (Hazard Ratio=5.4, 95% CI=3.5, 8.3). The impact of CHF hospitalization on the 5-year cumulative probability of survival is shown.
Conclusions: CHF hospitalization was strongly associated with death in ACHD population. ACHD patients at older age, of male sex, with severe native CHD lesion, previous CHF history, or comorbidities are at increased risk of having CHF hospitalization within a year. These data will be used to calculate a clinically useful risk score for CHF hospitalization to identify patients for accelerated referral to specialized ACHD centers.
Author Disclosures: S. Cohen: None. A. Liu: None. L. Guo: None. J. Therrien: None. A.J. Marelli: None.
- © 2016 by American Heart Association, Inc.