title: Heart failure admissions in adults with congenital heart disease; risk factors and prognosis.
abstract: BACKGROUND
  Heart failure (HF) is a serious complication and often the cause of death in adults with congenital heart disease (CHD). Therefore, our aims were to determine the frequency of HF-admissions, and to assess risk factors of first HF-admission and of mortality after first HF-admission in adults with CHD.
  
  
  METHODS
  The Dutch CONCOR registry was linked to the Hospital Discharge Registry and National Mortality Registry to obtain data on HF-admissions and mortality. Risk factors for both HF-admission and mortality were assessed using Cox regression models.
  
  
  RESULTS
  Of 10,808 adult patients (49% male), 274 (2.5%) were admitted for HF during a median follow-up period of 21 years. The incidence of first HF-admission was 1.2 per 1000 patient-years, but the incidence of HF itself will be higher. Main defect, multiple defects, and surgical interventions in childhood were identified as independent risk factors of HF-admission. Patients admitted for HF had a five-fold higher risk of mortality than patients not admitted (hazard ratio (HR)=5.3; 95% confidence interval 4.2-6.9). One- and three-year mortality after first HF-admission were 24% and 35% respectively. Independent risk factors for three-year mortality after first HF-admission were male gender, pacemaker implantation, admission duration, non-cardiac medication use and high serum creatinine.
  
  
  CONCLUSIONS
  The incidence of HF-admission in adults with CHD is 1.2 per 1000 patient-years. Mortality risk is substantially increased after HF-admission, which emphasises the importance to identify patients at high risk of HF-admission. These patients might benefit from closer follow-up and earlier medical interventions. The presented risk factors may facilitate surveillance.
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Zomer
authors.forename: I
authors.initials: I
authors.lastname: Vaartjes
authors.forename: E T
authors.initials: ET
authors.lastname: van der Velde
authors.forename: H M Y
authors.initials: HM
authors.lastname: de Jong
authors.forename: T C
authors.initials: TC
authors.lastname: Konings
authors.forename: L J
authors.initials: LJ
authors.lastname: Wagenaar
authors.forename: W F
authors.initials: WF
authors.lastname: Heesen
authors.forename: F
authors.initials: F
authors.lastname: Eerens
authors.forename: L H B
authors.initials: LH
authors.lastname: Baur
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: B J M
authors.initials: BJ
authors.lastname: Mulder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Admission; Adults; Congenital heart disease; Heart failure; Mortality