Tsang Wendy, Silversides Candice K, Rashid Mohammed, Roche S Lucy, Alonso-Gonzalez Rafael, Austin Peter C, Lee Douglas S
Division of Cardiology, Toronto General Hospital, University Health Network, Peter Munk Cardiovascular Center, University of Toronto, Toronto, Ontario, Canada.
Toronto Adult Congenital Heart Disease Program, Toronto, Ontario, Canada.
ESC Heart Fail. 2021 Oct;8(5):4139-4151. doi: 10.1002/ehf2.13529. Epub 2021 Aug 17.
While heart failure (HF) is a leading cause of death in adults with congenital heart disease (ACHD), few studies report contemporary outcomes after the first HF hospitalization. We examined outcomes of ACHD patients newly admitted for HF compared with ACHD patients without HF and the general HF population without ACHD.
Using population databases from a single-payer health system from 1994 to 2018, ACHD patients newly admitted for HF were matched 1:1 to ACHD patients without HF (n = 4030 matched pairs). Similarly, ACHD patients newly admitted for HF were matched 1:1 to HF patients without ACHD (n = 4336 matched pairs). Patients with ACHD and HF (median age 68 years, 45% women) experienced higher mortality in short-term [30 day adjusted hazard ratio (HR) 4.68, 95% confidence interval (CI) 4.06, 5.43, P < 0.001], near-term (1 year HR 3.87, 95% CI 3.77, 4.92, P < 0.001), and long-term (24 year HR 1.59, 95% CI 1.13, 2.36, P = 0.008) follow-up. Patients with ACHD and HF had fewer baseline cardiovascular comorbidities than non-ACHD HF but demonstrated higher 30 day (HR 1.56, 95% CI 1.41, 1.73, P < 0.001), 1 year (HR 1.30, 95% CI 1.20, 1.40, P < 0.001), and 24 year (HR 2.40, 95% CI 1.73, 3.38, P < 0.001) mortality. Those with ACHD and HF also exhibited higher cardiovascular readmission rates at 30 days with HRs 9.15 (95% CI; 8.00, 10.48, P < 0.001) vs. ACHD without HF, and 1.71 (95% CI; 1.54, 1.85, P < 0.001) vs. HF without ACHD, and the higher readmission risk extended to 10 year follow-up.
Adults with congenital heart disease patients with new HF have high risks of death and cardiovascular hospitalization, and preventative strategies to improve outcomes are urgently needed.
虽然心力衰竭（HF）是成人先天性心脏病（ACHD）患者的主要死因，但很少有研究报告首次因HF住院后的当代结局。我们比较了新入院的ACHD HF患者与无HF的ACHD患者以及无ACHD的一般HF人群的结局。
利用1994年至2018年单一支付者医疗系统的人群数据库，将新入院的ACHD HF患者与无HF的ACHD患者按1:1匹配（n = 4030对匹配）。同样，新入院的ACHD HF患者与无ACHD的HF患者按1:1匹配（n = 4336对匹配）。患有ACHD和HF的患者（中位年龄68岁，45%为女性）在短期（30天调整风险比[HR]4.68，95%置信区间[CI]4.06，5.43，P < 0.001）、近期（1年HR 3.87，95% CI 3.77，4.92，P < 0.001）和长期（24年HR 1.59，95% CI 1.13，2.36，P = 0.008）随访中死亡率更高。患有ACHD和HF的患者基线心血管合并症比无ACHD的HF患者少，但30天（HR 1.56，95% CI 1.41，1.73，P < 0.001）、1年（HR 1.30，95% CI 1.20，1.40，P < 0.001）和24年（HR 2.40，95% CI 1.73，3.38，P < 0.001）死亡率更高。患有ACHD和HF的患者30天时心血管再入院率也更高，与无HF的ACHD患者相比HR为9.15（95% CI；8.00，10.48，P < 0.001），与无ACHD的HF患者相比HR为1.71（95% CI；1.54，1.85，P < 0.001），且更高的再入院风险持续到10年随访。
患有新发性HF的先天性心脏病成人患者死亡和心血管住院风险高，迫切需要改善结局的预防策略。
