Extra-cardiac comorbidities or complications in adults with congenital heart disease: a nationwide inpatient experience in the United States

With a great interest, we read the article by Neidenbach et al. on non-cardiac comorbidities in German adults with congenital heart disease (ACHD). ACHD always bear an increased risk of developing concomitant non-cardiac comorbidities and complications and impose a great healthcare burden. Limited large-scale data from the United States (US) on this focus incited us to write this brief report. Gilboa et al. estimated nearly 2.4 million people living with CHD (1.4 million adults, 1 million children) in the US in 2010. To have a better nationwide prospect of the current scenario, we looked at the extra-cardiac comorbidities among ACHD patients hospitalized in the US using the National Inpatient Sample database (NIS) for years 2013-2014. The burden of extracardiac comorbidities among the NIS cohort in the US was diverse as compared to the German outpatient ACHD cohort. Our study reports a higher burden of endocrinological, hematological, metabolic, pulmonary, psychiatric, renal and rheumatological comorbidities as compared to the German cohort. However, the burden of gastrointestinal and hepatological comorbidities was higher in the German outpatient cohort. In addition, ACHD patients with non-cardiac comorbidities were older except for those suffering from the psychiatric illnesses as compared to ACHD hospitalizations without comorbidities. It is imperative for the clinicians to understand the non-cardiac complications which a patient might encounter during a lifetime, and which could further complicate the management of ACHD and increases the risk of mortality.