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Outcomes after initial heart failure consultation in Fontan patients

Published online by Cambridge University Press:  28 November 2023

Sharon Chen Open the ORCID record for Sharon Chen [Opens in a new window] ,
Muhammad F. Shezad ,
Angela Lorts ,
Amanda D. McCormick Open the ORCID record for Amanda D. McCormick [Opens in a new window] ,
Chad Y. Mao ,
Kathleen E. Simpson ,
Matthew J. O’Connor ,
Aliessa Barnes ,
Adam M. Lubert Open the ORCID record for Adam M. Lubert [Opens in a new window]  and
Chesney Castleberry
...Show all authors
Sharon Chen*
Affiliation:
Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA, USA
Muhammad F. Shezad
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Angela Lorts
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Amanda D. McCormick
Affiliation:
C.S. Mott Children’s Hospital, Ann Arbor, MI, USA
Chad Y. Mao
Affiliation:
Children’s Healthcare of Atlanta, Atlanta, GA, USA
Kathleen E. Simpson
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA
Matthew J. O’Connor
Affiliation:
Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Aliessa Barnes
Affiliation:
Children’s Mercy Kansas City, Kansas City, MO, USA
Adam M. Lubert
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Chesney Castleberry
Affiliation:
Dell Children’s Medical Center of Central Texas, Austin, TX, USA
Julie Schmidt
Affiliation:
Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA, USA
Katie Schroeder
Affiliation:
Stollery Children’s Hospital, Edmonton, Canada
Anna Joong
Affiliation:
Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
David W. Bearl
Affiliation:
Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Ashwin K. Lal
Affiliation:
Primary Children’s Hospital, Salt Lake City, UT, USA
Deepa Mokshagundam
Affiliation:
St. Louis Children’s Hospital, St. Louis, MO, USA
Jennifer Conway
Affiliation:
Stollery Children’s Hospital, Edmonton, Canada
Ari Cedars
Affiliation:
Johns Hopkins Hospital, Baltimore, MD, USA
Kurt R. Schumacher
Affiliation:
C.S. Mott Children’s Hospital, Ann Arbor, MI, USA
*
Corresponding author: S. Chen; Email: shchen@stanford.edu
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Abstract

Background:

Patients with Fontan failure are high-risk candidates for heart transplantation and other advanced therapies. Understanding the outcomes following initial heart failure consultation can help define appropriate timing of referral for advanced heart failure care.

Methods:

This is a survey study of heart failure providers seeing any Fontan patient for initial heart failure care. Part 1 of the survey captured data on clinical characteristics at the time of heart failure consultation, and Part 2, completed 30 days later, captured outcomes (death, transplant evaluation outcome, and other interventions). Patients were classified as “too late” (death or declined for transplant due to being too sick) and/or “care escalation” (ventricular assist device implanted, inotrope initiated, and/or listed for transplant), within 30 days. “Late referral” was defined as those referred too late and/or had care escalation.

Results:

Between 7/2020 and 7/2022, 77 Fontan patients (52% inpatient) had an initial heart failure consultation. Ten per cent were referred too late (6 were too sick for heart transplantation with one subsequent death, and two others died without heart transplantation evaluation, within 30 days), and 36% had care escalation (21 listed ± 5 ventricular assist device implanted ± 6 inotrope initiated). Overall, 42% were late referrals. Heart failure consultation < 1 year after Fontan surgery was strongly associated with late referral (OR 6.2, 95% CI 1.8–21.5, p=0.004).

Conclusions:

Over 40% of Fontan patients seen for an initial heart failure consultation were late referrals, with 10% dying or being declined for transplant within a month of consultation. Earlier referral, particularly for those with heart failure soon after Fontan surgery, should be encouraged.

Keywords

Fontan circulatory failureheart transplantationheart failure
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 8
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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