Eur J Prev Cardiol. 2025 Dec 16:zwaf763. doi: 10.1093/eurjpc/zwaf763. Online ahead of print.
ABSTRACT
BACKGROUND: Although international recommendations suggest follow-up care for adult congenital heart disease (ACHD) patients should be provided in either specialized ACHD care or non-specialized ACHD care by a general cardiologist, these guidelines are variably implemented based on local resources. We investigated levels of care used by ACHD patients, and predictors and outcomes of specialized ACHD follow-up, non-specialized ACHD follow-up, no cardiac follow-up and no follow-up.
METHODS AND RESULTS: We performed a longitudinal study in 10,459 patients across three hospitals in Belgium, covering 79,065 patient years. The outcomes of interest were the occurrence of heart failure, arrhythmias, valvular problems, infective endocarditis, myocardial ischemia, thromboembolic events, and pulmonary arterial hypertension. We used multivariable logistic regression to assess predictors of cardiac follow-up and multivariable Cox-regressions with time-varying lagged effects to explore associations with outcome. Specialized ACHD care was observed in 19% of all patient years, non-specialized ACHD follow-up in 25% of patient years, non-cardiac follow-up in 53% and no follow-up in 3%. While patients with complex defects are assumed to receive follow-up in specialized ACHD cardiac care, this was the case in only 52% of their patient years. Male sex, genetic syndrome and no intervention history were predictors for being in higher levels of follow-up. Follow-up in specialized ACHD care was protective for heart failure and myocardial ischemia. Any cardiac follow-up was protective for myocardial ischemia and thromboembolic events.
CONCLUSION: Both levels of specialized and non-specialized ACHD cardiac follow-up care were protective for certain clinical outcomes, highlighting the importance of cardiac follow-up in ACHD.
PMID:41401194 | DOI:10.1093/eurjpc/zwaf763