Hospitalization trends and health resource use for adult congenital heart disease-related heart failure

Abstract

Background-This study assessed trends in heart failure (HF) hospitalizations and health resource use in patients with adult congenital heart disease (ACHD). Methods and Results-The Nationwide Inpatient Sample was used to compare ACHD with non-ACHD HF hospitalization and health resource trends. Health resource use was assessed using total hospital charges, hospital length of stay, and procedural burden. A total of 87 175±2676 ACHD-related HF hospitalizations occurred between 1998 and 2011. During this time, ACHD HF hospitalizations increased 91% (4620±438-8809±740, P<0.0001) versus a 21% increase in non-ACHD HF hospitalizations (P=0.003). ACHD HF hospitalization was associated with longer length of stay (ACHD HF versus non-ACHD HF, 7.2±0.09 versus 6.8±0.02 days; P<0.0001), greater procedural burden, and higher charges (;$81 332±$1650 versus;$52 050±;$379; P<0.0001). ACHD HF hospitalization charges increased 258% during the study period (;$26 533±;$1816 in 1998 versus;$94 887±;$8310 in 2011; P=0.0002), more than double that for non-ACHD HF (P=0.04). Patients with ACHD HF hospitalized in high-volume ACHD centers versus others were more likely to undergo invasive hemodynamic testing (30.2±0.6% versus 20.7±0.5%; P<0.0001) and to receive cardiac resynchronization/defibrillator devices (4.7±0.3% versus 1.8±0.2%; P<0.0001) and mechanical circulatory support (3.9±0.2% versus 2.4±0.2%; P<0.0001). Conclusions-ACHD-related HF hospitalizations have increased dramatically in recent years and are associated with disproportionately higher costs, procedural burden, and health resource use.