Abstract 4142894: Multimorbidity Trajectories Across the Lifespan in Patients with Congenital Heart Disease

Background: Befitted from advances in medical care, patients with congenital heart disease (CHD) now survive to adulthood but face elevated risks of both cardiac and non-cardiac complications. Understanding the trajectories of comorbidity development over a patient's lifespan is cornerstone to optimize care expected to improve long-term health outcomes. Research Aim: This study aims to investigate the temporal sequences and evolution of comorbidities in CHD patients across their lifespan. We hypothesize that multimorbidity trajectories in CHD patients are linked to CHD lesion severity and age at onset of specific comorbidities. Methods: Using the Quebec CHD database which comprised data in outpatient visits, hospitalization records and vital status from 1983 to 2017, we designed a longitudinal cohort study evaluating the development of 39 comorbidities coded using ICD-9/10. Temporal sequences were mapped using median age of onset. Associations between disease pairs were quantified by hazard ratios from Cox proportional hazard models adjusting for age, sex, genetic syndrome, competing risks of death, and taking into account the time-varying nature of the predictor diseases. Results: The cohort included 9,764 individuals with severe and 127,729 with non-severe CHD lesions. In severe CHD patients, most comorbidities developed between ages 25 and 40. Comorbidity progression began with childhood cardiovascular diseases, followed by systemic diseases such as diabetes, liver and kidney diseases, and advanced to heart failure and dementia in middle adulthood. In addition, mental disorders emerged in early adulthood and were associated with subsequent development of kidney diseases and dementia. Different trajectories were observed in non-severe CHD patients with 2-3 decades later disease onsets and non-differential onsets between cardiovascular and systemic complications (Figure). Conclusions: Distinct multimorbidity trajectories were observed in CHD patients by CHD lesion severity. In patients with severe CHD lesions, early systemic diseases significantly influenced subsequent complications. These findings highlight the need for well-timed surveillance guidelines and interventions to improve health outcomes.