Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Heart. 2021 May;107(10):807-813. doi: 10.1136/heartjnl-2020-318246. Epub 2020 Dec 23.
Limited contemporary data exist regarding outcomes and resource use among adults with congenital heart disease and heart failure (ACHD-HF). This study compared outcomes, emergency department (ED) and hospital resource use, and advanced heart failure (HF) therapies in ACHD-HF versus non-ACHD with HF (HF-non-ACHD).
The Nationwide Emergency Department Sample and Nationwide Inpatient Sample were used to analyse outcomes and resource use among ACHD-HF ED visits and hospitalisations from 2006 to 2016. ACHD-HF was stratified by single-ventricle (SV) and two-ventricle (2V) disease.
A total of 76 557 ACHD-HF visits (3.6% SV physiology) and 31 137 414 HF-non-ACHD visits were analysed. ACHD-HFs were younger (SV 33 years (IQR 25-44), 2V 62 years (IQR 45-76); HF-non-ACHD 74 years (IQR 63-83); p<0.001). ACHD-HFs had higher ED admissions (78% vs 70%, p<0.001), longer hospital length of stay (5 days (IQR 2-8) vs 4 days (IQR 2-7), p<0.001) and greater hospital costs ($49K (IQR 2K-121K) vs $32K (17K-66K), p<0.001). Mortality was significantly higher among ACHD-HFs with SV physiology (6.6%; OR 1.6, 95% CI 1.1 to 2.3) or 2V physiology (6.3%; OR 1.4, 95% CI 1.3 to 1.5) versus HF-non-ACHD (5.5%). ACHF-HF hospitalisations increased more (46% vs 6% HF-non-ACHD) over a 10-year period, but the proportion receiving ventricular assist device (VAD) (ACHD-HF -2% vs HF-non-ACHD 294%) or transplant (ACHD-HF -37% vs HF-non-ACHD 73%) decreased.
ACHD-HFs have significant ED and hospital resource use that has increased over the past 10 years. However, advanced HF therapies (VAD and transplantation) are less commonly used compared with those without adult congenital heart disease.
关于患有先天性心脏病和心力衰竭（ACHD-HF）的成年人的结局和资源利用，目前仅有有限的当代数据。本研究比较了 ACHD-HF 与非 ACHD 心力衰竭（HF-non-ACHD）患者在急诊科（ED）和医院资源利用以及晚期心力衰竭（HF）治疗方面的结局。
使用全国急诊部样本和全国住院患者样本，分析了 2006 年至 2016 年期间 ACHD-HF ED 就诊和住院的结局和资源利用。根据单心室（SV）和双心室（2V）疾病对 ACHD-HF 进行分层。
共分析了 76557 例 ACHD-HF 就诊（SV 生理学 3.6%）和 31137414 例 HF-non-ACHD 就诊。ACHD-HF 患者年龄更小（SV 33 岁（IQR 25-44），2V 62 岁（IQR 45-76）；HF-non-ACHD 74 岁（IQR 63-83）；p<0.001）。ACHD-HF 患者 ED 入院率更高（78% vs 70%，p<0.001），住院时间更长（5 天（IQR 2-8）vs 4 天（IQR 2-7），p<0.001），住院费用更高（$49K（IQR 2K-121K）vs $32K（17K-66K），p<0.001）。SV 生理学（6.6%；OR 1.6，95%CI 1.1-2.3）或 2V 生理学（6.3%；OR 1.4，95%CI 1.3-1.5）的 ACHD-HF 患者死亡率显著高于 HF-non-ACHD（5.5%）。在过去的 10 年中，ACHD-HF 患者的住院人数增加了 46%（vs HF-non-ACHD 的 6%），但接受心室辅助装置（VAD）（ACHD-HF -2% vs HF-non-ACHD 294%）或移植（ACHD-HF -37% vs HF-non-ACHD 73%）的比例却有所下降。
ACHD-HF 患者 ED 和医院资源利用明显增加，在过去 10 年中呈上升趋势。然而，与非成人先天性心脏病患者相比，晚期 HF 治疗（VAD 和移植）的应用较少。
