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Original research
Adult patients with congenital heart disease in the intensive care unit
  1. Karishma Priyadarshani Ramlakhan1,
  2. Maaike van der Bie2,
  3. Corstiaan A den Uil3,
  4. Eric A Dubois4,
  5. Jolien W Roos-Hesselink2
  1. 1Department of Cardiology and Department of Obstetrics & Gynaecology, Erasmus MC, Rotterdam, The Netherlands
  2. 2Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
  3. 3Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, The Netherlands
  4. 4Department of Intensive Care Medicine and Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Jolien W Roos-Hesselink, Department of Cardiology, Erasmus MC, Rotterdam 3015GD, The Netherlands; j.roos{at}erasmusmc.nl

Abstract

Objective Current data on intensive care unit (ICU) admissions in patients with adult congenital heart disease (ACHD) are limited and focus on admissions after elective cardiac surgery. This study describes non-elective ICU admissions in patients with ACHD.

Methods A retrospective matched cohort study was performed from January 2000 until December 2015 in a tertiary care centre ICU (there was no cardiac care unit). Primary outcomes were short-term (during hospital stay or <30 days after discharge) and long-term (>30 days after discharge until end of follow-up) mortality. Outcomes were compared with non-ACHD non-elective ICU admissions, matched 1:1 on age, sex and admission diagnosis.

Results A total of 138 admissions in 104 patients with ACHD (65.9% male, median age 30 years) were included, during 8.6 years of follow-up. The majority had a moderate-to-severe heart defect. Arrhythmia was the most common admission diagnosis (44.2%), followed by haemorrhage (10.9%), heart failure (8.7%) and pulmonary disease (8.7%). Short-term mortality and total mortality were lower in the ACHD admissions than in the non-ACHD admissions (4.8% vs 16.3%, p=0.005 and 17.3% vs 28.9%, p=0.030), whereas long-term (12.5% vs 12.6%, p=0.700) did not differ. Severe CHD (HR 3.1, 95% CI 1.1 to 8.6) at baseline, and mechanical circulatory support device use (8.3, 1.4 to 47.4) and emergency intervention (0.2, 0.1 to 0.7) during the ICU stay were independently associated with mortality in the ACHD group.

Conclusions Non-elective ICU admissions in patients with ACHD are most often for arrhythmia and in patients with moderate-to-severe CHD. Reassuringly, short-term and total mortality are lower compared with patients without ACHD, however, long-term mortality is higher than expected for patients with ACHD.

  • Heart Defects, Congenital

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • Contributors Study design—KPR and JWR-H. Data collection—KPR and MvdB. Data interpretation—all authors. Manuscript draft—KPR and MvdB. Critical revision, editing and approval of the final manuscript—all authors. Guarantor—JWR-H.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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