Objectives
To describe the epidemiology, clinical characteristics, and outcomes of adult congenital heart disease (ACHD) patients admitted to intensive care units (ICUs) across Queensland, Australia.
Design
A multicenter, retrospective cohort study.
Setting
Twelve adult ICUs across Queensland, including tertiary referral and regional centers, from January 1, 2015, to December 31, 2021.
Participants
Adults (≥18 years) with ACHD.
Interventions
No interventions.
Measurements and Main Results
ACHD cases were stratified by lesion complexity and admission type (medical vs surgical). Outcomes included ICU and hospital length of stay and 30-day and 1-year mortality.
Of 89,184 ICU admissions, 1,870 (2.1%) involved ACHD. The most common diagnoses were valvular (57.9%) and septal (31.0%) malformations. Lesion complexity was classified as simple (1,543/1,870; 82.5%), moderate (220/1,870; 11.8%), and complex (60/1,870; 3.2%). Medical patients (253/1,870; 13.5%) had greater illness severity, more frequent use of renal replacement therapy and ECMO, and longer ICU (3 [2-6] v 2 [2-6] days; p < 0.001) and hospital length of stay: 18 [10-33] v 8 [6-13] days; p < 0.001) when compared to surgical patients. Mortality was significantly higher in medical admissions (30 day: 34/253: 13.4%; 1 year: 50/253: 19.8%) than in surgical (30 day: 20/1,617: 1.2%; 1 year: 42/1617: 2.6%; p < 0.001). One-year mortality was also higher in patients with complex lesions (11/60; 18.3%) versus simple (67/1,543; 4.3%).
Conclusions
ACHD patients are an uncommon but important ICU population. Outcomes vary significantly by admission type and lesion complexity. Emergency and medical admissions are associated with disproportionately high mortality compared to elective surgical admissions and should prompt early escalation of care.
Ashby, A. C., Anstey, C., Siriwardena, M., Mullany, D., Raman, S., Kumar, A., Pryke, C., Laupland, K. B., Tabah, A., Shekar, K., Blank, S., Whebell, S., Luke, S., Garrett, P., McCullough, J., White, K. C., Ramanan, M., Attokaran, A. G., Ramanan, M.,…Keogh, S. (2025). Epidemiology and Outcomes of Patients with Adult Congenital Heart Disease in Queensland Intensive Care Units: A Multicentre Retrospective Observational Study. Journal of Cardiothoracic and Vascular Anesthesia.
Queensland Critical Care Research Network 