Contemporary outcomes and health care costs associated with single-ventricle heart failure admissions in adults in the United States

OBJECTIVE: Advances in surgical and medical therapies have enabled patients with single-ventricle (SV) physiology to survive into adulthood, leading to a growing population of adults with SV congenital heart disease (SV-ACHD). This study aims to characterize contemporary SV-ACHD health care utilization and outcomes in comparison to acquired heart failure (HF). METHODS: The National Inpatient Sample was queried for the years 2016-2021 to identify all nonelective hospital admissions for HF or cardiogenic shock in patients aged 18 years or older. Patients with a diagnosis of common ventricle, double-inlet ventricle, tricuspid atresia, or hypoplastic left heart syndrome were identified as SV-ACHD. Patients with 2-ventricle congenital diagnoses were excluded, leaving a control group of acquired HF. Demographics, comorbidities, procedure utilization, in-hospital mortality, and total hospital costs were assessed. RESULTS: There were 28,402 843 HF admissions identified, of which 3375 (0.01%) were SV-ACHD. SV-ACHD admissions were younger and had differing comorbidities. Patients with SV-ACHD had prolonged length of stay, increased rates of advanced HF therapy, and increased hospital cost. There was no absolute difference in in-hospital mortality (5.8% vs 5.7%; P = .908); mortality rates decreased over time in SV-ACHD patients (odds ratio, 0.79; 95% CI, 0.66-0.96; P = .017). However, in multivariable analysis, SV-ACHD was associated with increased risk of mortality (odds ratio, 1.876; 95% CI, 1.210-2.907; P = .005). CONCLUSIONS: SV-ACHD represents a small proportion of adult HF admissions, although they have increased rates of procedure utilization and increased total costs. Risk of in-hospital mortality has improved over time in SV-ACHD patients, but there remains an increased risk of mortality relative to patients with acquired HF.