Original Articles Open access

Emergency care of adult patients with congenital heart disease: are we prepared? Data from a tertiary center and long-term follow-up

Authors

Published
26 September 2024
Section
Original Articles
DOI
10.4081/ecj.2024.12879

Abstract

A growing number of Congenital Heart Disease (CHD) patients will achieve adulthood. We aim to assess the characteristics, clinical course, and outcomes of Adult CHD (ACHD) patients attending the Emergency Department (ED) of a referral center. Seventy-five patients, 35 females (47%) were included. The mean age was 40 (±15) years. 35 patients (47%) had complex defects, and 29 patients (39%) were in NYHA class III-IV. Main symptoms were: dyspnea 22 (29 %), palpitations 20 (27%), fever 8 (11%), syncope 6 (8%), neurologic symptoms 7 (9.3%), chest pain 5 (7%). Heart failure and arrhythmias accounted for 23 (31%) and 20 (27%) of ED diagnoses. Twenty-eight patients (37%) were discharged, one patient died during observation, 32 patients (69 %) were admitted to a cardiology ward, 6 (13%) to the intensive care unit, and 8 (17%) to a non-cardiological ward. At a follow-up of 701 (554-984) days, 10 patients (13%) died, 2 (2.6%) were transplanted, 3 (4%) were listed for a heart transplant, and 30 (41 %) were re-admitted. In multivariate analysis, complex anatomy was weakly associated with readmissions. These preliminary data indicate that attendance of ACHD patients is epidemiologically relevant.

Keywords

References

  1. Agarwal S, Sud K, Khera S, et al. Trends in the Burden of Adult Congenital Heart Disease in US Emergency Departments. Clin Cardiol 2016;39:391-8. DOI: https://doi.org/10.1002/clc.22541
  2. Diller GP, Kempny A, Alonso-Gonzalez R, et al. Survival Prospects and Circumstances of Death in Contemporary Adult Congenital Heart Disease Patients Under Follow-Up at a Large Tertiary Centre. Circulation 2015;132:2118-25. DOI: https://doi.org/10.1161/CIRCULATIONAHA.115.017202
  3. Chessa M, Brida M, Gatzoulis MA, et al. Emergency department management of patients with adult congenital heart disease: a consensus paper from the ESC Working Group on Adult Congenital Heart Disease, the European Society for Emergency Medicine (EUSEM), the European Association for Cardio-Thoracic Surgery (EACTS), and the Association for Acute Cardiovascular Care (ACVC) Eur Heart J 2021;42:2527-35. DOI: https://doi.org/10.1093/eurheartj/ehab272
  4. Ntiloudi D, Dimopoulos K, Tzifa A, et al. Hospitalizations in adult patients with congenital heart disease: an emerging challenge. Heart Fail Rev 2021;26:347-53. DOI: https://doi.org/10.1007/s10741-020-10026-0
  5. Verheugt CL, Uiterwaal CS, van der Velde ET, et al. The emerging burden of hospital admissions of adults with congenital heart disease. Heart 2010;96:872-8. DOI: https://doi.org/10.1136/hrt.2009.185595
  6. Cross KP, Santucci KA. Transitional medicine: will emergency medicine physicians be ready for the growing population of adults with congenital heart disease? Pediatr Emerg Care 2006;22:775-81. DOI: https://doi.org/10.1097/01.pec.0000245178.13418.4f
  7. Kaemmerer H, Bauer U, Pensl U, et al. Management of Emergencies in Adults With Congenital Cardiac Disease. Am J Cardiol 2008;101:521-5. DOI: https://doi.org/10.1016/j.amjcard.2007.09.110
  8. Koh AS, Yap BT, Le Tan J. Emergency admissions in Asians with adult congenital heart disease. Int J Cardiol 2011;151:54-7. DOI: https://doi.org/10.1016/j.ijcard.2010.04.088
  9. Soufi A, Colman JM, Li Q, et al. Revision: review of non-elective hospitalisations of adults with CHD. Cardiol Young 2017;27:1764-70. DOI: https://doi.org/10.1017/S1047951117001214
  10. Opotowsky AR, Siddiqi OK, Webb GD. Trends in Hospitalizations for Adults With Congenital Heart Disease in the U.S. J Am Coll Cardiol 2009;54:460-7. DOI: https://doi.org/10.1016/j.jacc.2009.04.037
  11. Benderly M, Buber J, Kalter-Leibovici O, et al. Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population-Based Study. J Am Heart Assoc 2021;10:e018037 DOI: https://doi.org/10.1161/JAHA.120.018037
  12. Willems R, Werbrouck A, De Backer J, Annemans L. Real-world healthcare utilization in adult congenital heart disease: a systematic review of trends and ratios. Cardiol Young 2019;29:553-63. DOI: https://doi.org/10.1017/S1047951119000441
  13. Tutarel O, Kempny A, Alonso-Gonzalez R, et al. Congenital heart disease beyond the age of 60: emergence of a new population with high resource utilization, high morbidity, and high mortality. Eur Heart J 2014;35:725-32. DOI: https://doi.org/10.1093/eurheartj/eht257
  14. Kaemmerer H, Fratz S, Bauer U, et al. Emergency hospital admissions and three-year survival of adults with and without cardiovascular surgery for congenital cardiac disease. J Thorac Cardiovasc Surg 2003;126:1048-52. DOI: https://doi.org/10.1016/S0022-5223(03)00737-2
  15. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;139:e698-800. DOI: https://doi.org/10.1161/CIR.0000000000000602
  16. Mylotte D, Pilote L, Ionescu-Ittu R, et al. Specialized adult congenital heart disease care: the impact of policy on mortality. Circulation 2014;129:1804-12. DOI: https://doi.org/10.1161/CIRCULATIONAHA.113.005817
  17. Gales J, Krasuski RA, Awerbach JD. Emergency department evaluation of chest pain among adult congenital heart disease patients. Am Heart J 2020;222:191-8. DOI: https://doi.org/10.1016/j.ahj.2020.02.001
  18. Moore JP, Khairy P. Adults with Congenital Heart Disease and Arrhythmia Management. Cardiol Clin 2020;383:417-34. DOI: https://doi.org/10.1016/j.ccl.2020.04.006
  19. Ferrero P, Krishnathasan K, Constantine A, et al. Pulmonary arterial hypertension in congenital heart disease. Heart 2024;110:1145-52.
  20. Noble J, Amdani SM, Garcia RU, Arora R. Hematuria in an Adult with Congenital Heart Disease J Emerg Med 2018;54:e69-71. DOI: https://doi.org/10.1016/j.jemermed.2017.12.050
  21. Havers-Borgersen E, Butt JH, Østergaard L, et al. Long-term incidence 451 of infective endocarditis among patients with congenital heart disease. Am Heart J 2023;259:9-20. DOI: https://doi.org/10.1016/j.ahj.2023.01.012
  22. Kuijpers JM, Koolbergen DR, Groenink M, et al. Incidence, risk factors, and predictors of infective endocarditis in adult congenital heart disease: focus on the use of prosthetic material. Eur Heart J 2017;38:2048-56. DOI: https://doi.org/10.1093/eurheartj/ehw591
  23. Awh K, Venuti MA, Gleason LP, et al. Clinic nonattendance is associated with increased emergency department visits in adults with congenital heart disease. Congenit Heart Dis 2019;14:726-34. DOI: https://doi.org/10.1111/chd.12784
  24. Verheugt CL, Uiterwaal CS, van der Velde ET, et al. Mortality in adult congenital heart disease. Eur Heart J 2010;31:1220-9. DOI: https://doi.org/10.1093/eurheartj/ehq032

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