Nationwide Hospitalization Trends in Adult Congenital Heart Disease Across 2003–2012

Abstract

BackgroundWe aimed to assess trends in hospitalization, outcomes, and resource utilization among patients admitted with adult congenital heart disease (ACHD).Methods and ResultsWe used the 2003–2012 US Nationwide Inpatient Sample for this study. All admissions with an ACHD were identified using standard ICD codes. Resource utilization was assessed using length of stay, invasive procedure utilization, and cost of hospitalization. There was a significant increase in the number of both simple (101%) as well as complex congenital heart disease (53%)–related admissions across 2003–2012. In addition, there was a considerable increase in the prevalence of traditional cardiovascular risk factors including older age, along with a higher prevalence of hypertension, diabetes, smoking, obesity, chronic kidney disease, and peripheral arterial disease. Besides miscellaneous causes, congestive heart failure (11.8%), valve disease (15.5%), and cerebrovascular accident (26.1%) were the top causes of admission to the hospital among patients with complex ACHD, simple ACHD without atrial septal defects/patent foramen ovale and simple atrial septal defects/patent foramen ovale patients, respectively. In‐hospital mortality has been relatively constant among patients with complex ACHD as well as simple ACHD without atrial septal defects/patent foramen ovale. However, there has been considerable increase in the average length of stay and cost of hospitalization among the ACHD patients during 2003–2012.ConclusionsThere has been a progressive increase in ACHD admissions across 2003–2012 in the United States, with increasing healthcare resource utilization among these patients. Moreover, there has been a change in the cardiovascular comorbidities of these patients, adding a layer of complexity in management of ACHD patients.

Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease–Related Heart Failure

“…HF is now a major focus in ACHD specialist care worldwide, accounting for up to one third of all ACHD hospitalizations 6, 16. The 91% increase in ACHD HF hospitalizations observed in this study reflects not only an expansion of the overall population with ACHD but an increasing burden of late‐onset HF often occurring years after surgical repair.…”

“…For the population with adult CHD (ACHD), heart failure (HF) is now the leading cause of mortality2, 3 and accounts for almost one third of deaths 4. Our nascent understanding of ACHD‐related HF is largely restricted to observational studies and outcomes reported by tertiary ACHD centers,3, 5 an important limitation because many ACHD hospitalizations occur in smaller hospitals with less exposure to ACHD 6. Studies of nationwide ACHD hospital admissions have provided preliminary insights into ACHD HF hospitalization trends,6, 7 but without sufficient detail to inform existing HF services or to anticipate future health resource needs.…”

“…Our nascent understanding of ACHD‐related HF is largely restricted to observational studies and outcomes reported by tertiary ACHD centers,3, 5 an important limitation because many ACHD hospitalizations occur in smaller hospitals with less exposure to ACHD 6. Studies of nationwide ACHD hospital admissions have provided preliminary insights into ACHD HF hospitalization trends,6, 7 but without sufficient detail to inform existing HF services or to anticipate future health resource needs. Little is known about the clinical profile of patients with ACHD HF, including where they are being hospitalized, healthcare costs, and whether treatment varies between high‐ versus low‐volume ACHD centers.…”

Hospital resource utilization and presence of advance directives at the end of life for adults with congenital heart disease

“…9,10 However, information is limited regarding resource utilization patterns for patients with ACHD specifically at the end of life. The time period near the end of life is associated with costs well beyond the day-to-day cost of care for patients with chronic illness and can be associated with unwanted or burdensome intensity of care.…”

Pulmonary Arterial Hypertension in Adults with Congenital Heart Disease: Can We Predict its Development?

“…As compared to GUCH subjects aged between 20 and 60 years, those over 60 years of age need greater healthcare resources as outlined by considering the number of outpatient clinic visits and number and length of hospitalization of these patients [2]. The cardiovascular causes of admission to the hospital depend on complexity of CHD: congestive heart failure is the most frequent condition induced hospital admission and it is more frequent in patients suffering from complex disorders, including tetralogy of Fallot, truncus arteriosus and transposition of great arteries; valvular disease related cardiac decompensation is found in patients with simple disorder without atrial septal defect (ASD) or patent foramen ovale; finally, cerebrovascular event are the main cause of admission in case of patients suffering from simple atrial septal defect or patent foramen ovale [3]. Pulmonary arterial hypertension (PAH) represents an important complication of CHD, affecting about 10% of GUCH patients [4].…”