Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease-Related Heart Failure

Abstract

Background This study assessed trends in heart failure ( HF) hospitalizations and health resource use in patients with adult congenital heart disease ( ACHD ). Methods and Results The Nationwide Inpatient Sample was used to compare ACHD with non- ACHD HF hospitalization and health resource trends. Health resource use was assessed using total hospital charges, hospital length of stay, and procedural burden. A total of 87 175±2676 ACHD -related HF hospitalizations occurred between 1998 and 2011. During this time, ACHD HF hospitalizations increased 91% (4620±438-8809±740, P<0.0001) versus a 21% increase in non- ACHD HF hospitalizations ( P=0.003). ACHD HF hospitalization was associated with longer length of stay ( ACHD HF versus non- ACHD HF, 7.2±0.09 versus 6.8±0.02 days; P<0.0001), greater procedural burden, and higher charges ($81 332±$1650 versus $52 050±$379; P<0.0001). ACHD HF hospitalization charges increased 258% during the study period ($26 533±$1816 in 1998 versus $94 887±$8310 in 2011; P=0.0002), more than double that for non- ACHD HF ( P=0.04). Patients with ACHD HF hospitalized in high-volume ACHD centers versus others were more likely to undergo invasive hemodynamic testing (30.2±0.6% versus 20.7±0.5%; P<0.0001) and to receive cardiac resynchronization/defibrillator devices (4.7±0.3% versus 1.8±0.2%; P<0.0001) and mechanical circulatory support (3.9±0.2% versus 2.4±0.2%; P<0.0001). Conclusions ACHD -related HF hospitalizations have increased dramatically in recent years and are associated with disproportionately higher costs, procedural burden, and health resource use.

Keywords: health services research; heart failure; mortality.

Figure 1

Deriving the analytic samples. ASD indicates atrial septal defect; HF, heart failure; ICD‐9, International Classification of Diseases, Ninth Revision.

Figure 2

Adult congenital heart disease (ACHD; A) vs non‐ACHD (B) heart failure (HF) annual hospitalization trends, 1998 to 2011.

Figure 3

Adult congenital heart disease (ACHD; A) vs non‐ACHD (B) primary heart failure (HF) hospitalizations, 1998 to 2011.

Figure 4

Adult congenital heart disease (ACHD) vs non‐ACHD heart failure (HF) hospitalizations across age groups.

Figure 5

Adult congenital heart disease heart failure (HF) hospitalizations by International Classification of Diseases, Ninth Revision (ICD‐9) code and anatomic subgroup.

Figure 6

Total hospital charges for adult congenital heart disease (ACHD; A) vs non‐ACHD (B) heart failure (HF) hospitalizations, 1998 to 2011.

Figure 7

A and B, Procedural trends in adult congenital heart disease (ACHD) heart failure (HF) hospitalizations. Please note that in B, the trend for central, right‐ and left‐sided heart catheterizations has been removed to enable scale adjustment and review of heart transplant and mechanical circulatory support.