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Advanced heart failure in adult congenital heart disease: the role of renal dysfunction in management and outcomes

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Title: Advanced heart failure in adult congenital heart disease: the role of renal dysfunction in management and outcomes
Authors: Krishnathasan, K
Dimopoulos, K
Duncan, N
Ricci, P
Kempny, A
Rafiq, I
Gatzoulis, M
Heng, EL
Blakey, S
Montanaro, C
Babu-Narayan, S
Francis, D
Li, W
Constantine, A
Item Type: Journal Article
Abstract: Aims Previous studies in adult congenital heart disease (CHD) have demonstrated a link between renal dysfunction and mortality. However, the prognostic significance of renal dysfunction in CHD and decompensated heart failure (HF) remains unclear. We sought to assess the association between renal dysfunction and outcomes in adults with CHD presenting to our centre with acute HF between 2010 and 2021. Methods and results This retrospective analysis focused on the association between renal dysfunction, pre-existing and on admission, and outcomes during and after the index hospitalization. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Cox regression analysis was used to identify the predictors of death post-discharge. In total, 176 HF admissions were included (mean age 47.7 ± 14.5 years, 43.2% females). One-half of patients had a CHD of great complexity, 22.2% had a systemic right ventricle, and 18.8% had Eisenmenger syndrome. Chronic kidney disease was present in one-quarter of patients. The median length of intravenous diuretic therapy was 7 (4–12) days, with a maximum dose of 120 (80–160) mg furosemide equivalents/day, and 15.3% required inotropic support. The in-hospital mortality rate was 4.5%. The 1- and 5-year survival rates free of transplant or ventricular assist device (VAD) post-discharge were 75.4% [95% confidence interval (CI): 69.2–82.3%] and 43.3% (95% CI: 36–52%), respectively. On multivariable Cox analysis, CKD was the strongest predictor of mortality or transplantation/VAD. Highly complex CHD and inpatient requirement of inotropes also remained predictive of an adverse outcome. Conclusion Adult patients with CHD admitted with acute HF are a high-risk cohort. CKD is common and triples the risk of death/transplantation/VAD. An expert multidisciplinary approach is essential for optimizing outcomes.
Issue Date: Sep-2023
Date of Acceptance: 23-Mar-2023
URI: http://hdl.handle.net/10044/1/103564
DOI: 10.1093/eurjpc/zwad094
ISSN: 2047-4873
Publisher: Oxford University Press
Start Page: 1335
End Page: 1342
Journal / Book Title: European Journal of Preventive Cardiology
Volume: 30
Issue: 13
Copyright Statement: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Publication Status: Published
Article Number: zwad094
Online Publication Date: 2023-03-28
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine

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