This study found that the prevalence of CRT DRI is close to 4.3% at 2.6 years (1.7% per year incidence). Four independent predictive factors of infections were identified including re-intervention, procedure time, dialysis, and primo CRT-ICD implantation. These parameters should be part of the risk-benefit evaluation in patients selected for CRT implantation.

Background Previous studies in adult congenital heart disease “CHD” have demonstrated a link between renal dysfunction and mortality. However, the prognostic significance of renal dysfunction in CHD and decompensated heart failure “HF” remains unclear. We sought to assess the association of renal dysfunction and outcomes in adults with CHD presenting to our center with acute HF between 2010-2021. Design & Methods This retrospective analysis focused on the association between renal dysfunction, pre-existing and on admission, and outcomes during and after the index hospitalization. Chronic kidney disease “CKD” was defined as eGFR<60 mL/min/1.73m2. Cox regression analysis was used to identify predictors of death post-discharge. Results In total, 176 HF admissions were included (mean age 47.7±14.5 years, 43.2% female). One-half of patients had CHD of great complexity, 22.2% had a systemic right ventricle, and 18.8% Eisenmenger syndrome. CKD was present in one-quarter of patients. The median length of intravenous diuretic therapy was 7[4-12] days, with a maximum dose of 120[80-160] mg furosemide equivalents/day, and 15.3% required inotropic support. In-hospital mortality was 4.5%. The 1- and 5-year survival free of transplant or ventricular assist device “VAD” post-discharge were 75.4% (95%CI: 69.2-82.3%) and 43.3% (95%CI: 36-52%), respectively. On multivariable Cox analysis, CKD was the strongest predictor of mortality or transplantation/VAD. Greatly complex CHD and inpatient requirement of inotropes also remained predictive of an adverse outcome. Conclusions Adult CHD patients admitted with acute HF are a high-risk cohort. CKD is common and triples the risk of death/transplantation/VAD. Expert multidisciplinary approach is essential for optimizing outcomes.

Aims Less than one third of adolescents with congenital heart disease (CHD) successfully transition to adult care, missing out on education of their cardiac condition and risking loss to follow-up. We assessed the efficacy of our transition clinic on patient education and empowerment, and identified correlates of successful transition. Methods and Results Overall, 592 patients were seen at least once in our transition service between 2015 and 2022 (age 15.2 ± 1.8 years, 47.5% female). Most adolescents (53%) had moderate CHD, followed by simple (27.9%) and severe (19.1%) CHD. Learning disability (LD) was present in 18.9% and physical disability (PD) in 4.7%. In patients without LD, knowledge of their cardiac condition improved significantly from the first to the second visit (naming their condition: from 20% to 52.3%, P < 0.0001; describing: 14.4% to 42.7%, P < 0.0001; understanding: 26.1% to 60.7%, P < 0.0001), and from the second to the third (naming: 67.4%, P = 0.004, describing: 61.4%, P < 0.001, understanding: 71.1%, P = 0.02;). Patients with LD did not improve their disease knowledge over time (all P > 0.05). Treatment adherence and management involvement, self-reported anxiety and dental care awareness did not change over time. Successful transition (attendance of ≥ 2 clinics) was achieved in 49.3%. Younger age at the first visit, simpler CHD and absence of PD were associated with successful transition. Conclusion A transition service positively impacts on patient education and empowerment in most CHD adolescents transitioning to adult care. Strategies to promote a tailored support for patients with LD should be sought, and earlier engagement should be encouraged to minimise follow-up losses.