Jani Thuraiaiyah

Background and Aims: Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized in the general population, but the prevalence among adults with congenital heart disease (ACHD) is not well described. The study aimed to determine the prevalence, characteristics, and hospitalization burden of HFpEF among ACHD patients. Methods: Using the electronic medical files, a retrospective, multicentre cohort study was conducted including 4507 ACHD patients with biventricular heart physiology and systemic left ventricle followed at the ACHD centres in Eastern Denmark. Heart failure with preserved ejection fraction was defined as preserved left ventricular ejection fraction (LVEF ≥ 50%) with diuretics use, combined with elevated N-terminal pro-B-type natriuretic peptide and/or echocardiographic signs of HFpEF. Results: Among 4507 ACHD patients, 86% had a preserved LVEF. Heart failure with preserved ejection fraction was identified in 13%, with high prevalence across all ACHD severities (13%, 12%, and 18% in mild, moderate, and severe). Compared with patients with normal left ventricular function, HFpEF patients were older {median age: 60 [interquartile range (IQR) 47–70] vs 41 [IQR 29–56] years, P < .001}, had more comorbidities {age-adjusted odds ratio for diabetes: 15.60 [95% confidence interval (CI) 12.39–19.70]; obesity: 1.48 [95% CI 1.17–1.87], and atrial fibrillation 4.58 [95% CI 2.22–9.88]}, and experienced almost five-fold higher rate of cardiovascular hospitalization [incidence rate ratio 4.6 (95% CI 4.2–5.1), P < .0001]. Despite this, only 4.0% had a heart failure diagnosis, and 5.8% were treated with a sodium-glucose cotransporter 2 (SGLT2) inhibitor. Conclusions: Heart failure with preserved ejection fraction is highly prevalent among ACHD patients, regardless of ACHD severity. It is associated with an increased burden of cardiovascular risk factors and hospitalizations. Despite this, only a minority received SGLT2 inhibitors. These findings emphasize the need for increased awareness of HFpEF in the ACHD population.

Aims: Academic achievement of children with congenital heart disease (CHD) has not been comprehensively studied across the entire CHD severity spectrum. Methods and results: Through nationwide registries, we identified all children with CHD who reached 16 years of age and matched each child with CHD to controls who attended an elementary school-leaving examination in the same year and municipality from 2001 to 2022. The school performance of children with CHD was evaluated based on the rank of their mean exam score and risk of failing the exam when compared with matched controls. Between 2001 and 2022, 10 717 children with CHD and 229 738 matched controls participated in the exam. Children with CHD ranked lower in the mean exam score compared with controls [0.47 (95% confidence interval (CI): 0.46–0.48) vs. 0.50 (95% CI: 0.50–0.50)], with a reduced rank value of 0.48 (0.47–0.48) for mild CHD, 0.46 (0.45–0.47) for moderate CHD, and 0.44 (0.42–0.47) for severe CHD (all P < 0.0001). Furthermore, 27.5% of the CHD children failed the exam compared with 19.0% of the controls [adjusted odds ratio (aOR): 1.45 (95% CI: 1.37–1.53), P < 0.0001], with an aOR for failing the exam of 1.35 (1.26–1.44) for mild CHD, 1.54 (1.39–1.72) for moderate CHD, and 2.27 (1.86–2.77) for severe CHD. Preterm birth, previous cardiac intervention, cardiopulmonary bypass, and hospitalization were associated with lower exam score and higher risk of failing the exam. Over time, school performance among CHD children worsened from 0.49 (95% CI: 0.47–0.51) to 0.47 (95% CI: 0.45–0.48). Conclusion: School performance was impaired in all children with CHD, regardless of disease severity. These findings advocate for a better surveillance and school support for children with CHD to help improve their educational outcomes.

Background: The congenital heart disease (CHD) population is growing and aging. We aim to examine the impact by describing the temporal trend and causes of lifetime hospitalization burden among the CHD population. Methods and Results: From the Danish National Patient Registry, 23 141 patients with CHD and their hospitalizations from 1977 to 2018 were identified, excluding patients with extracardiac malformation. Patients with CHD were categorized into major CHD and minor CHD, and each patient was matched with 10 controls by sex and year of birth. The rate of all‐cause hospitalization increased over time from 28.3 to 36.4 hospitalizations per 100 person‐years (PY) with rate difference (RD) per decade of 2.5 (95% CI, 2.0–3.1) hospitalizations per 100 PY for the patients with CHD, compared with the increase from 10.8 to 17.0 per 100 PY (RD per decade, 2.0 [95% CI, 1.8–2.2] per 100 PY) for the control group (RD for CHD versus control, P =0.08). The all‐cause hospitalization rate remained constant for the major CHDs (RD per decade, −0.2 [95% CI, −1.2 to 0.9] per 100 PY) but increased for the minor CHDs (RD per decade, 5.2 [95% CI, 4.3–6.0] per 100 PY). For all patients with CHD, the cardiovascular hospitalization rate remained constant over time (RD per decade, 0.2 [95% CI, −0.3 to 0.6] per 100 PY) whereas the noncardiovascular hospitalization rate increased (RD per decade, 2.1 [95% CI, 1.6–2.7] per 100 PY). The length of all‐cause hospital stays for all patients with CHD decreased from 2.7 (95% CI, 2.6–2.8) days per PY in 1977 to 1987 to 1.6 (95% CI, 1.6–1.7) days per PY in 2008 to 2018. Conclusions: Compared with previous decades, patients with CHD have an increasing hospitalization rate, similar to the general population, but a decreasing length of hospital stay. The increase in hospitalization rate was driven by noncardiovascular hospitalizations, with the patients with minor CHD being the key contributor to the increasing rate.

The decisions about placing an ICD in a child are more difficult than in an adult due to longer expected lifespan and the complication risk. Young patients gain the most years from ICDs, despite higher risk of device-related complications. The secondary prevention ICD indication is clear, and device is implanted regardless of potential complications. For primary prevention, risk of sudden cardiac death and complications need to be evaluated. We aimed to compare outcomes for primary and secondary prevention ICDs. Retrospective nationwide cohort study including paediatric patients identified from the Danish ICD registry with ICD implanted at an age ≤ 15 from 1982–21. Demographics, complications (composite of device-related infections or lead-failure requiring re-operation, mortality because of arrhythmia, or unknown cause), and mortality were retrieved from medical charts. Endpoint was appropriate therapy (shock or anti-tachycardia pacing for ventricular tachycardia or fibrillation). Of 72 receiving an ICD, the majority had channelopathies (n = 34) or structural heart diseases (n = 28). ICDs were implanted in 23 patients for primary prevention and 49 for secondary prevention, at median ages of 13.8 and 11.6 years (P-value 0.01), respectively. Median follow-up was 9.0 (interquartile ranges: 4.7–13.5) years. The 10-year cumulative incidence of first appropriate therapy was 70%, with complication and inappropriate therapy rates at 41% and 15%, respectively. No difference was observed between prevention groups for all outcomes. Six patients died during follow-up. In children, two-thirds are secondary prevention ICDs. Children have higher appropriate therapy and complication rates than adults, while the inappropriate therapy rate was low.

Despite rehospitalization being common after transcatheter aortic valve implantation (TAVI), an in-depth analysis on this topic is missing. This study sought to report on the incidence, predictors, and prognostic impact of rehospitalization within one year following TAVI. All consecutive patients treated with TAVI between 2016 and 2020 in East Denmark were included. Medical records of all patients were reviewed to validate rehospitalizations up to 1 year after discharge from the index admission. The study population consisted of 1,397 patients, of whom 615 (44%) had an unplanned rehospitalization within the first year post-TAVI. The rehospitalization incidence rate was 3-fold higher in the early period (within 30 days) compared with the late period (30 days to 1 year; 2.5 vs. 0.8 per patient-year, respectively; p < 0.001). Predictors of early unplanned rehospitalization were procedure-related complications and prior stroke, whereas late unplanned rehospitalization was associated with pre-existing comorbidities. Predictors of HF rehospitalization included ischemic heart disease, the extent of cardiac damage, atrial fibrillation, and NYHA class at baseline. HF rehospitalization within 30 days and 1-year post-TAVI was associated with a markedly increased 1-year and 5-year mortality risk (hazard ratio (HR) of 4.3 and 3.2 for 1-year mortality and HR of 3.2 and 2.9 for 5-year mortality, respectively; p < 0.001). Rehospitalization after TAVI is frequent in real-world practice. Early rehospitalization is mostly procedure-related whereas late rehospitalization is related to pre-existing comorbidities. HF rehospitalization is associated with poor long-term survival and could be validated as a prognostically relevant endpoint for TAVI trials.