Trends in Hospitalizations and Racial Disparities in Rates of Procedures in Adults Hospitalized with Congenital Heart Disease

Purpose Advancements in care of children with congenital heart disease (CHD) has led to an increasing adult population living with CHD that frequently requires hospitalizations and procedural interventions. We aim to describe temporal trends in hospitalizations and heart failure (HF)-related procedural volume in adults with CHD stratified by race. Methods Hospitalizations for adults ≥18 years with a diagnosis of CHD from January 1, 2000 to December 31, 2017 in the Nationwide Inpatient Sample were identified. Hospitalizations were trended over years using Poisson regression and expressed as average annual percent change (AAPC), stratified by race. A yearly aggregate sum of HF-related procedures (valvular interventions, heart transplants, and left ventricular assist device implants) similarly trended by race. Results Overall, 1,472,565 hospitalizations were identified. Total as well as primary cardiovascular hospitalizations significantly increased across all races (AAPC: White 8% and 7%, respectively; Black 9% and 9%, Hispanic 8% and 8%, other 7% and 8%). Rates of HF-related procedures were 145 per 1000 hospitalizations in White patients, 57 per 1000 in Black patients, 103 per 1000 in Hispanic patients, and 138 per 1000 in patients of other races. From 2000 to 2017, procedural rates increased in patients of all races: White (130 per 1000 to 163, p Conclusion Rate of hospitalizations and HF-related procedures increased in patients with CHD from 2000 to 2017. Black and Hispanic patients had significantly fewer procedures compared to White patients regardless of insurance type. Further studies are needed to better ascertain the causes behind demographic disparities in procedural volumes in patients with CHD and to raise awareness among patients and providers.