Language

English

Publication Date

10-1-2025

Journal

JACC: Advances

DOI

10.1016/j.jacadv.2025.101710

PMID

40310330

PMCID

PMC12541205

PubMedCentral® Posted Date

4-30-2025

PubMedCentral® Full Text Version

Post-print

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.

Keywords

adult congenital heart disease (ACHD), cardiac intensive care unit (CICU), atrial arrhythmias, critical care outcomes, in-hospital mortality, post-ICU readmission

Published Open-Access

yes

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