Abstract 4371069: Adult Congenital Heart Disease and Atrial Fibrillation: A Double Burden on Cardiovascular Outcomes

Background: With 97% of congenital heart disease (CHD) patients now reaching adulthood, the risk of cardiovascular disease, including atrial fibrillation (AF), is higher compared to the general population. Hypothesis: We hypothesize that AF patients with CHD have worse cardiovascular outcomes compared to those without. Methods: This is a retrospective cohort using the REACHnet database from 2010 to 2019. Kaplan-Meier curves and log-rank test were used to study time-to-death, cardiovascular event and hospitalization. Cox regression was used to adjust for age, sex, BMI, hypertension, and diabetes, CHD as confounders. Chi-square and t-test were used to compare categorical and continuous variables, respectively. Results: In total, 5947 AF subjects were included in our analysis, among which 60 (1.0%) were diagnosed with CHD. Most of our CHD cohort had a left-to-right shunt lesion (n=31, 51.7%). AF patients with CHD were significantly more likely to have hypertension (81.7% vs 42.8%, p <0.0001), diabetes mellitus (40.0% vs 23.3%, p =0.002), chronic kidney disease (23.3% vs 11.9%, p =0.007) and strokes (36.7% vs 8.7%, p <0.0001), and had lower BMI (28.25 + 8.2 vs 31.0 + 8.0 , p =0.007) compared to those without. They were also more frequently on antiarrhythmic drugs (16.7% vs 6.0%, p =0.004) and anticoagulants (68.3% vs 35.4%, p <0.0001). There was no difference between the two groups in terms of age ( p =0.318), sex ( p =0.285) and race ( p =0.450). Kaplan-Meier curves showed a significantly shorter time to stroke ( p <0.0001) (Figure 1E), myocardial infarction ( p <0.0001) (Figure 1D) and congestive heart failure ( p =0.001) (Figure 1C) in the CHD group. Patients with CHD had higher risk of stroke (HR = 2.78, 95% CI 1.75–4.43, p <0.0001), and MI (HR = 2.56, 95% CI 1.43–4.61, p =0.004). There was no significant mortality ( p =0.1) (Figure 1A) or hospitalization difference ( p =0.44) (Figure 1B) between the groups. Conclusion: Our preliminary analysis showed that AF patients with CHD have higher stroke and MI risk compared to those without. There was no difference in mortality, CHF and hospitalization between the two groups. Our results suggest that both CHD and AF may contribute to adverse cardiovascular outcomes.