Contemporary outcomes and healthcare costs associated with single-ventricle heart failure admissions in adults in the United States.

Objective: Advances in surgical and medical therapies have enabled patients with single-ventricle physiology to survive into adulthood, leading to a growing population of adults with single-ventricle congenital heart disease (SV-ACHD). This study aims to characterize contemporary SV-ACHD healthcare utilization and outcomes, in comparison to acquired heart failure (HF).

Methods: The National Inpatient Sample (NIS) was queried for the years 2016-2021 to identify all non-elective hospital admissions for HF or cardiogenic shock in patients aged ≥18. Patients with a diagnosis of common ventricle, double-inlet ventricle, tricuspid atresia, or hypoplastic left heart syndrome were identified as SV-ACHD. Patients with two-ventricle congenital diagnoses were excluded, leaving a control group of acquired HF. Demographics, comorbidities, procedure utilization, in-hospital mortality, and total hospital costs were assessed.

Results: There were 28,402,843 HF admissions identified, of which 3,375 (0.01%) were SV-ACHD. SV-ACHD admissions were younger and had differing comorbidities. Patients with SV-ACHD had prolonged length of stay, increased rates of advanced heart failure therapy, and increased hospital cost. There was no absolute difference in in-hospital mortality (5.8 vs. 5.7%, p=0.908); mortality rates decreased over time in SV-ACHD patients (OR 0.79 [0.66-0.96], p = 0.017). However, in multivariable analysis, SV-ACHD was associated with increased risk of mortality (OR 1.876, 95% confidence interval 1.210-2.907, p=0.005).

Conclusions: SV-ACHD represents a small proportion of adult HF admissions, though they have increased rates of procedure utilization and increased total costs. Risk of in-hospital mortality has improved over time in SV-ACHD patients, but there remains an increased risk of mortality relative to patients with acquired HF.