Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.).
McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, QC, Canada (F.W., A.L., A.M.).
Circ Heart Fail. 2020 Aug;13(8):e006490. doi: 10.1161/CIRCHEARTFAILURE.119.006490. Epub 2020 Jul 16.
Nearly 90% of patients with adult congenital heart disease (ACHD) die after the age of 40 years, and heart failure (HF) is the most common cause of death. We aimed to characterize the association between an incident HF hospitalization (HFH) and mortality and to identify the predictors of 1-year postdischarge mortality after incident and repeated HFHs, respectively.
Patients with ACHD aged ≥40 years between 2000 and 2010 were identified from the Québec CHD database. We conducted a propensity score-matched study to explore the association between an incident HFH and mortality. We performed Bayesian model averaging to identify the predictors of 1-year postdischarge mortality with a posterior probability ≥50% considered to be evidence of a significant association.
The mortality hazard ratio was high at 6.01 (95% CI, 4.02-10.72) within 1-year postdischarge, decreasing significantly but entering an elevated equilibrium until year 4 with a continued 3-fold increase in death. Kidney dysfunction (hazard ratio, 2.28 [95% credible interval, 1.59-3.28], posterior probability, 100.0%) and a history of ≥2 HFHs in the past 12 months (hazard ratio, 1.77 [95% credible interval, 1.18-2.66], posterior probability: 82.2%) were the most robust predictors of 1-year mortality after incident and repeated HFHs, respectively.
In patients with ACHD aged ≥40 years, incident HFH was associated with high mortality risk at 1 year, declining but remaining elevated for 4 years. Kidney dysfunction was a potent predictor of 1-year mortality risk after incident HFHs. Repeated HFHs further increased mortality risk. These observations should inform early risk-tailored health services interventions for monitoring and prevention of HF and its associated complications in older patients with ACHD.
近 90%的成人先天性心脏病（ACHD）患者在 40 岁后死亡，心力衰竭（HF）是最常见的死亡原因。我们旨在描述首次 HF 住院（HFH）与死亡率之间的关联，并分别确定首次和重复 HFH 后 1 年出院后死亡率的预测因素。
从 2000 年至 2010 年，从魁北克先天性心脏病数据库中确定了年龄≥40 岁的 ACHD 患者。我们进行了倾向评分匹配研究，以探讨首次 HFH 与死亡率之间的关联。我们使用贝叶斯模型平均法来确定 1 年出院后死亡率的预测因素，具有≥50%后验概率的预测因素被认为具有显著关联的证据。
首次 HFH 后 1 年内的死亡率危险比很高，为 6.01（95%置信区间，4.02-10.72），显著下降，但在第 4 年进入一个升高的平衡期，死亡风险持续增加 3 倍。肾功能障碍（危险比，2.28[95%可信区间，1.59-3.28]，后验概率，100.0%）和过去 12 个月内≥2 次 HFH 病史（危险比，1.77[95%可信区间，1.18-2.66]，后验概率：82.2%）是首次和重复 HFH 后 1 年死亡率的最可靠预测因素。
在年龄≥40 岁的 ACHD 患者中，首次 HFH 与 1 年内的高死亡率风险相关，风险下降但在 4 年内仍保持升高。肾功能障碍是首次 HFH 后 1 年死亡率风险的有力预测因素。重复 HFH 进一步增加了死亡率风险。这些观察结果应该为监测和预防老年 ACHD 患者 HF 及其相关并发症提供早期风险定制的卫生服务干预措施。
