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      Determinants of Survival in Older Adults With Congenital Heart Disease Newly Hospitalized for Heart Failure

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          Abstract

          Background:

          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.

          Methods:

          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.

          Results:

          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.

          Conclusions:

          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.

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          Most cited references34

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          Congenital heart disease in the general population: changing prevalence and age distribution.

          Empirical data on the changing epidemiology of congenital heart disease (CHD) are scant. We determined the prevalence, age distribution, and proportion of adults and children with severe and other forms of CHD in the general population from 1985 to 2000. Where healthcare access is universal, we used administrative databases that systematically recorded all diagnoses and claims. Diagnostic codes conformed to the International Classification of Disease, ninth revision. Severe CHD was defined as tetralogy of Fallot, truncus arteriosus, transposition complexes, endocardial cushion defects, and univentricular heart. Prevalence of severe and other CHD lesions was determined in 1985, 1990, 1995, and 2000 using population numbers in Quebec. Children were subjects <18 years of age. The prevalence was 4.09 per 1000 adults in the year 2000 for all CHD and 0.38 per 1000 (9%) for those with severe lesions. Female subjects accounted for 57% of the adult CHD population. The median age of all patients with severe CHD was 11 years (interquartile range, 4 to 22 years) in 1985 and 17 years (interquartile range, 10 to 28 years) in 2000 (P<0.0001). The prevalence of severe CHD increased from 1985 to 2000, but the increase in adults was significantly higher than that observed in children. In the year 2000, 49% of those alive with severe CHD were adults. The prevalence in adults and median age of patients with severe CHD increased in the general population from 1985 to 2000. In 2000, there were nearly equal numbers of adults and children with severe CHD.
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            Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010.

            Our objective was to obtain contemporary lifetime estimates of congenital heart disease (CHD) prevalence using population-based data sources up to year 2010.
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              Task force 1: the changing profile of congenital heart disease in adult life.

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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                Circulation: Heart Failure
                Circ: Heart Failure
                Ovid Technologies (Wolters Kluwer Health)
                1941-3289
                1941-3297
                August 2020
                August 2020
                : 13
                : 8
                Affiliations
                [1 ]Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada (F.W., J.M.B., M.A., G.P.).
                [2 ]McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, QC, Canada (F.W., A.L., A.M.).
                [3 ]Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (J.M.B.).
                [4 ]Hospital Marie Lannelongue, Congenital Heart Diseases Department, Complex Congenital Heart Diseases M3C Network, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France (S.C.).
                Article
                10.1161/CIRCHEARTFAILURE.119.006490
                32673500
                4c95de59-3da4-4624-96d6-7277d59cd262
                © 2020
                History

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