title: Contemporary Hospitalization Rate Among Adults With Complex Congenital Heart Disease.
abstract: BACKGROUND
  Adults with congenital heart disease are hospitalized at increasing rates in the Western world. Identification of rates of and risk factors for hospitalization is essential for research and improving patient outcomes.
  
  
  METHODS
  We conducted a single-center retrospective analysis of patients with a primary diagnosis of tetralogy of Fallot (TOF), transposition of the great arteries (both d- and l-transposition of the great arteries [TGAs]), or single ventricle (SV). We investigated the rates of mortality, annual hospitalization, and patient-specific risk factors for unplanned cardiac hospitalization.
  
  
  RESULTS
  Adult patients with complex congenital heart disease are hospitalized at a rate four to eight times greater than the general US population (P < .001). In addition, there are significant differences between the rates of hospitalization in TOF and TGA (0.39 and 0.41 hospitalizations per patient-year, respectively) and SV (0.72 hospitalizations per patient-year). The majority of excess hospitalizations in the study group were due to cardiac disease (P < .001 for all three groups). Risk factors for unplanned cardiac hospitalization in TOF included pulmonary atresia, depressed left ventricular and right ventricular ejection fraction, and smoking; in TGA, they included Ebstein malformation, surgeries other than primary repair, noncardiac diagnoses, atrial arrhythmias, atrioventricular nodal block, left ventricular ejection fraction, and smoking; and in SV, they included atrial arrhythmias and cyanosis.
  
  
  CONCLUSIONS
  Patients born with complex congenital heart disease are hospitalized far more frequently than the general US population, primarily for cardiac-related illness. Future research should focus on confirming the present findings and on identification of strategies to improve outcomes in this growing group of patients.
authors.affiliation: Department of Cardiology, Baylor University Hospital, Dallas, TX, USA acedars97@gmail.com.
authors.forename: Ari
authors.initials: A
authors.lastname: Cedars
authors.affiliation: Department of Cardiology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Benjamin
authors.affiliation: Department of Cardiology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Vyhmeister
authors.affiliation: Department of Medicine, Meharry School of Medicine, Nashville, TN, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Harris
authors.affiliation: Department of Cardiology, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
authors.forename: Elisa A
authors.initials: EA
authors.lastname: Bradley
authors.affiliation: Department of Internal Medicine, Rush University School of Medicine, Chicago, IL, USA.
authors.forename: Subeer
authors.initials: S
authors.lastname: Wadia
authors.affiliation: Department of Cardiology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Ahmed J
authors.initials: AJ
authors.lastname: Awad
authors.affiliation: Department of Cardiology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
mesh_terms: D000328:Adult; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000401:mortality / Q000628:therapy*; D014188:Transposition of Great Vessels / Q000401:mortality / Q000628:therapy*
keywords: CHD; adult congenital heart disease; database; outcomes; statistics; univentricular heart