Introduction:
Heart failure (HF) is common in the adult congenital heart disease (ACHD) population. We sought to assess outcomes of cardiogenic shock (CS) and assess the trends of utilization of mechanical circulatory support (MCS) in these patients.
Methods:
Using the nationwide inpatient sample (NIS) database for the years 2007-2017, adult patients with a primary discharge diagnosis of HF, and a co-diagnosis of CS were identified. They were divided into 2 groups - patients with ACHD and those without ACHD. Statistical significance was assigned at p<.05.
Results:
Out of the 114420 patients with HF who developed CS, 2572 (2.3%) patients had ACHD, and demonstrated an increasing yearly trend (Figure 1). Patients with ACHD were younger (55 vs 64.7 years, p<.01), and had lower rates of comorbidities like hypertension (24.8 vs 38.3 %, p<.01), diabetes mellitus (15.9 vs 27.5 %, p<.01) and chronic ischemic heart disease (27.1 vs 42.1 %, p<.01). Utilization of temporary MCS (25.9 vs 14.8 %, p<.01), Left ventricular assist device (LVAD) (28.4 vs 7.6 %, p<.01), and orthotopic heart transplantation (OHT) (8.0 vs 2.9 %, p<.01) was higher in the ACHD group. Yearly trends are shown in Figure 2. Patients with ACHD had lower in-hospital mortality (16.6 vs 23.7 %, p<.01) and lower adjusted odds of death [0.79 (CI 0.62,0.99), p<.04], but had longer length of stay (22.6 vs 14.6 days, p<.01) and total charges during hospitalization ($444007 vs $212972, p<.01).
Conclusion:
Although low, the rates of CS in ACHD patients is increasing, however, these patients had a lower mortality, likely driven by lower age, fewer comorbidities, and increased utilization of MCS and heart transplantation.
Mechanical Circulatory Support for Patients With Adult Congenital Heart Disease
