Clinical Profiles and Outcomes of Adult Congenital Heart Disease Patients in the Cardiac Intensive Care Unit

Abstract

Background

There is limited evidence to guide care and improve outcomes among critically ill adult congenital heart disease (ACHD) patients.

Objectives

The purpose of this study was to examine the clinical profile and outcomes of ACHD patients admitted to an academic cardiac intensive care unit (CICU).

Methods

Retrospective cohort study of Mayo Clinic CICU admissions (2007-2018), including those who had been evaluated in our ACHD clinic. Critical care diagnoses (CCD) at the time of admission and critical care therapies (CCT) during the CICU stay were examined. Logistic regression and Cox proportional hazards regression were used to evaluate in-hospital and 1-year mortality, respectively.

Results

Among 12,428 unique CICU admissions, 253 (2.0%) had ACHD (52.6% female, median age 41.5 [IQR: 31.5-53.5] years), classified as severe in 103 (40.9%); 49.0% had a CCD or CCT. Compared to non-ACHD, ACHD patients were more likely to have heart failure, atrial and ventricular arrhythmias. In-hospital mortality occurred in 22 (8.7%) ACHD patients and was higher among patients with CCD or requiring CCT, especially severe ACHD. One-year survival was lower for those with CCD (64.1% vs 87.5%, P < 0.001) or CCT (68.5% vs 84.5%; P = 0.001). Following multivariable adjustment, ACHD patients had higher in-hospital mortality (adjusted OR: 1.76; 95% CI: 1.01-2.94; P = 0.04) and higher risk of 1-year mortality (adjusted HR: 1.42; 95% CI: 1.06-1.89; P = 0.02). A total of 101 (43.9%) hospital survivors were readmitted within 1 year.

Conclusions

ACHD patients in the CICU experience high readmission rates and mortality. Tailored treatment strategies are needed to improve outcomes for critical ACHD patients.