Heart failure admissions in adults with congenital heart disease; risk factors and prognosis

A. C. Zomer, I. Vaartjes, E. T. van der Velde, H. M. Y. de Jong, T. C. Konings, L. J. Wagenaar, W. F. Heesen, F. Eerens, L. H. B. Baur, D. E. Grobbee, B. J. M. Mulder*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.
Original languageEnglish
Pages (from-to)2487-2493
JournalInternational Journal of Cardiology
Issue number3
Publication statusPublished - 3 Oct 2013


  • Adults
  • Congenital heart disease
  • Heart failure
  • Admission
  • Mortality

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