Nationwide hospitalizations of patients with down syndrome and congenital heart disease over a 15-year period

TL;DR

This study examines hospitalization trends and mortality risks in people with Down syndrome and heart disease in Italy over 15 years.

Contribution

The study identifies younger age at first hospital admission as a mortality predictor and shows how multiple heart-related hospitalizations increase future readmission risks.

Findings

Younger age at first hospital admission predicts higher mortality in Down syndrome patients with heart disease.

Patients with multiple hospital admissions face a higher risk of future readmissions.

Heart-related hospitalizations are strongly linked to increased mortality and readmission risks.

Abstract

Down syndrome is one of the most common genetic diseases, generally associated with an increased probability of congenital heart diseases. This increased risk contributes to escalated levels of morbidity and mortality. In this study, we sought to analyze nationwide data of pediatric and adult patients with Down syndrome and congenital heart disease over a 15-year period. Data obtained from the hospital discharge form between 2001 and 2016 of patients diagnosed with Down syndrome in Italy and at least one congenital heart disease were included. Information on 12362 admissions of 6527 patients were included. Age at first admission was 6.2 ± 12.8 years and was a predictor of mortality (HR = 1.51, 95% CI 1.13–2.03, p = 0.006). 3923 (60.1%) patients underwent only one admission, while 2604 (39.9%) underwent multiple (> 1) admissions. There were 5846 (47.3%) admissions for cardiac related symptoms. Multiple admissions (SHR: 3.13; 95% CI: 2.99, 3.27; P < 0.01) and cardiac admissions (SHR: 2.00; 95% CI: 1.92, 2.09; P < 0.01) were associated with an increased risk of additional potential readmissions. There was an increased risk of mortality for patients who had cardiac admissions (HR = 1.45, 95% CI: 1.08–1.94, p = 0.012), and for those who underwent at least 1 cardiac surgical procedure (HR = 1.51, 95% CI 1.13–2.03, p = 0.006).

Conclusions: A younger age at first admission is a predictor for mortality in patients with Down syndrome and congenital heart disease. If patients undergo more than one admission, the risk of further readmissions increases. There is a pivotal role for heart disease in influencing the hospitalization rate and subsequent mortality.

What is Known:• Down syndrome individuals often face an increased risk of congenital heart diseases.• Congenital heart diseases contribute significantly to morbidity and mortality in Down syndrome patients.What is New:• This study analyzes nationwide data covering a 15-year period of pediatric and adult patients in Italy with Down syndrome and congenital heart disease.• It identifies a younger age at first admission as a predictor for mortality in these patients, emphasizing the criticality of early intervention.• Demonstrates a correlation between multiple admissions, particularly those related to cardiac issues, and an increased risk of further readmissions, providing insights into the ongoing healthcare needs of these individuals.

What is Known:

• Down syndrome individuals often face an increased risk of congenital heart diseases.

• Congenital heart diseases contribute significantly to morbidity and mortality in Down syndrome patients.

What is New:

• This study analyzes nationwide data covering a 15-year period of pediatric and adult patients in Italy with Down syndrome and congenital heart disease.

• It identifies a younger age at first admission as a predictor for mortality in these patients, emphasizing the criticality of early intervention.

• Demonstrates a correlation between multiple admissions, particularly those related to cardiac issues, and an increased risk of further readmissions, providing insights into the ongoing healthcare needs of these individuals.

Figures