J Am Heart Assoc. 2025 Dec 10:e044374. doi: 10.1161/JAHA.125.044374. Online ahead of print.
ABSTRACT
BACKGROUND: Management strategies of unplanned hospitalizations (UPH) vary and have not been well characterized in patients with Fontan circulation.
METHODS: We prospectively followed 3226 Fontan patients for 3 years to characterize the current UPH status and elucidate the associations between in-hospital management strategies and postdischarge outcomes.
RESULTS: A total of 243 UPHs occurred (2.5 cases/100 person-years). Fontan-related UPHs accounted for 154 cases (63%), most commonly due to heart failure (19%), protein-losing enteropathy (16%), hemorrhage (14%), arrhythmia (9%), thromboembolism (3%), and plastic bronchitis (2%). Fontan-unrelated UPHs (89 cases; 37%) were mainly due to infections (19%). Adult patients were more frequently hospitalized for hemorrhage and thromboembolism (P<0.05). The longest length of hospital stay was observed in protein-losing enteropathy, followed by thromboembolism and heart failure. Among nonpharmacological treatments, oxygen therapy was commonly used, followed by surgical procedures and catheter-based interventions. Among pharmacological treatments, diuretics were commonly administered, followed by heparin and catecholamines. Of 240 patients discharged alive, 76 (15.4 cases/100 person-years) were readmitted. Protein-losing enteropathy was the most frequent cause of readmission, followed by heart failure and hemorrhage. In addition to conventional risk factors, in-hospital management practices, such as oxygen therapy, surgical intervention, and diuretic adjustment were associated with readmission risk (P<0.01-0.001).
CONCLUSIONS: We clarified real-world practices related to UPHs in Fontan patients. Specific in-hospital treatment strategies were associated with the risk of readmission. Further studies are warranted to determine the causal relationships between treatment approaches and outcomes for standardized management strategies.
PMID:41368820 | DOI:10.1161/JAHA.125.044374