Nationwide Hospitalization Trends in Adult Congenital Heart Disease Across 2003-2012

Abstract

Background: We aimed to assess trends in hospitalization, outcomes, and resource utilization among patients admitted with adult congenital heart disease (ACHD).

Methods and results: We used the 2003-2012 US Nationwide Inpatient Sample for this study. All admissions with an ACHD were identified using standard ICD codes. Resource utilization was assessed using length of stay, invasive procedure utilization, and cost of hospitalization. There was a significant increase in the number of both simple (101%) as well as complex congenital heart disease (53%)-related admissions across 2003-2012. In addition, there was a considerable increase in the prevalence of traditional cardiovascular risk factors including older age, along with a higher prevalence of hypertension, diabetes, smoking, obesity, chronic kidney disease, and peripheral arterial disease. Besides miscellaneous causes, congestive heart failure (11.8%), valve disease (15.5%), and cerebrovascular accident (26.1%) were the top causes of admission to the hospital among patients with complex ACHD, simple ACHD without atrial septal defects/patent foramen ovale and simple atrial septal defects/patent foramen ovale patients, respectively. In-hospital mortality has been relatively constant among patients with complex ACHD as well as simple ACHD without atrial septal defects/patent foramen ovale. However, there has been considerable increase in the average length of stay and cost of hospitalization among the ACHD patients during 2003-2012.

Conclusions: There has been a progressive increase in ACHD admissions across 2003-2012 in the United States, with increasing healthcare resource utilization among these patients. Moreover, there has been a change in the cardiovascular comorbidities of these patients, adding a layer of complexity in management of ACHD patients.

Keywords: adult congenital heart disease; cost of illness; hospital admission; length of stay; mortality; trends.

Figure 1

Projected annual national estimates of adult congenital heart disease admissions. A, Demonstrates the overall annual national estimates with 95% CIs. B, Demonstrates the national annual estimates, stratified into simple (black bars), complex (green bars), and unclassified defects (blue bars).

Figure 2

Projected annual national estimates of ACHD admissions after excluding patients with simple secundum ASD/PFO. A, Demonstrates the overall annual national estimates with 95% CIs. B, Demonstrates the projected annual national estimates, stratified into simple without ASD/PFO (black bars), complex (green bars), and unclassified defects (blue bars). ACHD indicates adult congenital heart disease; ASD, atrial septal defects; PFO, patent foramen ovale.

Figure 3

The figure demonstrates the changes in age (A) and sex distribution (B) among patients with congenital heart disease admitted during 2003–2012. In (A), the line demonstrates the trend in the mean age of patients over the study duration and the bars reflect the percentage of patients aged >60 years of age. In (B), blue line with squares demonstrates males and red line with circles demonstrates females.

Figure 4

This figure demonstrates the primary reasons for admission to the hospital among the included ACHD patients, stratified into complex ACHD (A), simple ACHD without ASD/PFO (B), and simple ASD/PFO lesions (C). The numbers next to the bars represent percentage of all patients in that particular stratum. ACHD indicates adult congenital heart disease; ASD, atrial septal defect; CAD, coronary artery disease; CHF, congestive heart failure; CVA, cerebrovascular accident; MI, myocardial infarction; PFO, patent foramen ovale; VTE, venous thromboembolism.

Figure 5

This figure demonstrates the proportion of emergency admissions across the study period, stratified into complex ACHD, simple ACHD without ASD/PFO, and simple ASD/PFO lesions. These estimates were only available from 2003 to 2011. ACHD indicates adult congenital heart disease; ASD, atrial septal defects; PFO, patent foramen ovale.

Figure 6

This figure demonstrates the annual in‐hospital mortality among patients admitted with complex ACHD, simple ACHD without ASD/PFO, and simple ASD/PFO. As evident in this figure, there was no significant difference in mortality in both complex ACHD (P‐trend=0.52) and simple ACHD without ASD/PFO (P‐trend=0.06) across the study period. ACHD indicates adult congenital heart disease; ASD, atrial septal defects; PFO, patent foramen ovale.

Figure 7

Resource utilization in simple (A) and complex adult congenital heart disease (B), evaluated using length of stay (days) and cost of hospitalization (US dollars, adjusted for inflation to 2012 estimates). In both panels, the line represents mean length of stay flanked by 95% CIs for respective years and the bars represent the annual mean cost of hospitalization.

Figure 8

The figure quantifies hospital admissions of patients with adult congenital heart disease (ACHD) to small‐ or medium‐sized hospitals. The red bars represent the proportion of all ACHD admissions that present to the small/medium‐sized hospitals across the study duration. The black line demonstrates the projected annual number of admissions to small or medium‐sized hospitals.