Zomer et al evaluated patients with congenital heart disease who are admitted for heart failure. They identified risk factors associated with a worse progrnosis. The authors are from multiple institutions in The Netherlands.
Patient selection: adult with congenital heart disease
Risk factors for heart failure:
(1) type of congenital heart defect (see below)
(2) multiple defects
(3) surgical intervention during childhood
(4) reoperation
(5) pacemaker implantation
High risk congenital heart defects:
(1) transposition of the great arteries (hazard ratio 5.0)
(2) congenitally correct transposition of the great arteries (hazard ratio 5.2)
(3) univentricular heart, double inlet left ventricle (hazard ratio 11.4)
Low to moderate risk:
(1) tetralogy of Fallot (hazard ratio 2.1)
(2) aortic stenosis (hazard ratio 1.9)
(3) atrioventricular septal defect (hazard ratio 2.7)
(4) pulmonary atresia + ventricular septal defect (hazard ratio 3.0)
Congenital heart defects with low hazard ratios:
(1) aortic coarction (hazard ratio 0.4)
(2) pulmonary stenosis (hazard ratio 0.6)
(3) bicuspid aortic valve (hazard ratio 0.7)
(4) Marfan syndrome (hazard ratio 0.8)
(5) patent ductus arteriosus (hazard ratio 0.6)
(6) Ebstein malformation (hazard ratio 0.7)
Risk factors for 3-year mortality after first admission for heart failure:
(1) male sex
(2) pacemaker implantation
(3) longer hospital stay
(4) non-cardiac medication use
(5) high serum creatinine
