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. 2024 Jul 22;3(8):101077.
doi: 10.1016/j.jacadv.2024.101077. eCollection 2024 Aug.

Characteristics and Outcomes of Adults With Congenital Heart Disease in the Cardiac Intensive Care Unit

Ryan R Keane  1 , Anthony P Carnicelli  2 , Daniel B Loriaux  3 , Payton Kendsersky  2 , Richard A Krasuski  3 , Kelly M Brown  3 , Kelly Arps  3 , Vivian Baird-Zars  4 , Jeffrey A Dixson  3 , Emily Echols  3 , Christopher B Granger  3 , Robert W Harrison  3 , Michael Kontos  5 , L Kristin Newby  3 , Jeong-Gun Park  4 , Kevin S Shah  6 , Bradley W Ternus  7 , Sean Van Diepen  8 , Jason N Katz  3 , David A Morrow  4
Affiliations

Characteristics and Outcomes of Adults With Congenital Heart Disease in the Cardiac Intensive Care Unit

Ryan R Keane et al. JACC Adv. .

Abstract

Background: Little is known regarding the characteristics, treatment patterns, and outcomes in patients with adult congenital heart disease (ACHD) admitted to cardiac intensive care units (CICUs).

Objectives: The authors sought to better define the contemporary epidemiology, treatment patterns, and outcomes of ACHD admissions in the CICU.

Methods: The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Participating centers contributed prospective data from consecutive admissions during 2-month annual snapshots from 2017 to 2022. We analyzed characteristics and outcomes of admissions with ACHD compared with those without ACHD. Multivariable logistic regression was used to assess mortality in ACHD vs non-ACHD admissions.

Results: Of 23,299 CICU admissions across 42 sites, there were 441 (1.9%) ACHD admissions. Shunt lesions were most common (46.1%), followed by right-sided lesions (29.5%) and complex lesions (28.7%). ACHD admissions were younger (median age 46 vs 67 years) than non-ACHD admissions. ACHD admissions were more commonly for heart failure (21.3% vs 15.7%, P < 0.001), general medical problems (15.6% vs 6.0%, P < 0.001), and atrial arrhythmias (8.6% vs 4.9%, P < 0.001). ACHD admissions had a higher median presenting Sequential Organ Failure Assessment score (5.0 vs 3.0, P < 0.001). Total hospital stay was longer for ACHD admissions (8.2 vs 5.9 days, P < 0.01), though in-hospital mortality was not different (12.7% vs 13.6%; age- and sex-adjusted OR: 1.19 [95% CI: 0.89-1.59], P = 0.239).

Conclusions: This study illustrates the unique aspects of the ACHD CICU admission. Further investigation into the best approach to manage specific ACHD-related CICU admissions, such as cardiogenic shock and acute respiratory failure, is warranted.

Keywords: ACHD; CICU; adult congenital heart disease; cardiac intensive care unit.

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Conflict of interest statement

Dr Morrow is a member of the TIMI Study Group, which has received institutional research grant support through Brigham and Women’s Hospital from 10.13039/100001316Abbott Laboratories, 10.13039/100020297Abiomed, 10.13039/100002429Amgen, 10.13039/100020132Anthos Therapeutics, 10.13039/100020305Arca Biopharma, 10.13039/100008207AstraZeneca, Daiichi-Sankyo, 10.13039/100014130Intarcia, 10.13039/100005565Janssen, 10.13039/100004334Merck, 10.13039/100008272Novartis, 10.13039/100004319Pfizer, Poxel, Quark Pharmaceuticals, 10.13039/100009857Regeneron, Roche, 10.13039/100004340Siemens, and Zora Biosciences; and he has received consulting fees from Abbott Laboratories, Arca Biopharma, InCarda, Inflammatix, Merck, Novartis, and Roche Diagnostics. Dr Krasuski has served as a consultant for Actelion/Janssen Pharmaceuticals, Bayer, Gore Medical, Medtronic and Neptune Medical; has received research funding from the Adult Congenital Heart Association and Actelion/Janssen Pharmaceuticals; and has served as a principal investigator for trials with Artivion, Corvia, Edwards Lifesciences, and Medtronic. Dr Newby has received research support through Duke University from 10.13039/100004374Medtronic, BioKier, and 10.13039/100016545Roche Diagnostics; and consulting honoraria from Medtronic and CSL-Behring. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Primary Admission Diagnosis Stratified by Admissions With and Without Adult Congenital Heart Disease ∗∗P < 0.05. ACHD = adult congenital heart disease.
Figure 2
Figure 2
Cardiac Intensive Care Unit Resource Utilization Stratified by Admissions With and Without Adult Congenital Heart Disease ∗∗P < 0.05. ACHD = adult congenital heart disease; CICU = cardiac intensive care unit; NIPPV = noninvasive positive pressure ventilation; PAC = pulmonary artery catheter; RHC = right heart catheterization.
Figure 3
Figure 3
Cardiac Intensive Care Unit and Hospital Length of Stay Stratified Admissions With and Without Adult Congenital Heart Disease Median number of days reported in box plot. Diamond denotes the mean. ∗∗P < 0.05. ACHD = adult congenital heart disease; CICU = cardiac intensive care unit; Hx = history.
Central Illustration
Central Illustration
Characteristics and Outcomes of Adults With Congenital Heart Disease in the Cardiac Intensive Care Unit: The Critical Care Cardiology Trials Network Readmission was evaluated for index hospitalization only. ACHD = adult congenital heart disease; CICU = cardiac intensive care unit; PAC = pulmonary artery catheter; SOFA = Sequential Organ Function Score.
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References

    1. Khairy P., Ionescu-Ittu R., Mackie A.S., Abrahamowicz M., Pilote L., Marelli A.J. Changing mortality in congenital heart disease. J Am Coll Cardiol. 2010;56:1149–1157. - PubMed
    1. Marelli A.J., Mackie A.S., Ionescu-Ittu R., Rahme E., Pilote L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation. 2007;115:163–172. - PubMed
    1. Thakkar A.N., Chinnadurai P., Lin C.H. Adult congenital heart disease: magnitude of the problem. Curr Opin Cardiol. 2017;32:467–474. - PubMed
    1. Lui G.K., Saidi A., Bhatt A.B., et al. Diagnosis and management of Noncardiac complications in adults with congenital heart disease: a Scientific Statement from the American heart Association. Circulation. 2017;136:e348–e392. - PubMed
    1. Verheugt C.L., Uiterwaal C.S., van der Velde E.T., et al. The emerging burden of hospital admissions of adults with congenital heart disease. Heart. 2010;96:872–878. - PubMed

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