Comparative Congenital Cardiac Catheterization Registry Analysis From the United States and Low- and Middle-Income Countries

TL;DR

This study compares congenital cardiac catheterization practices and outcomes between the U.S. and low- to middle-income countries, highlighting differences in patient complexity and adverse events.

Contribution

The paper provides a harmonized comparative analysis of CCC practices across high-income and low- to middle-income countries using large registries.

Findings

U.S. patients had higher complexity and longer procedure durations compared to LMIC patients.

Adverse event rates were higher in the U.S., but mortality was similar between the two groups.

Risk-adjusted outcomes showed lower adverse event rates in LMICs, but higher failure-to-rescue rates.

Abstract

Disparities in congenital heart disease care exist between high-income and low- and middle-income countries (LMICs), likely extending to congenital cardiac catheterization (CCC).

This study compares patient characteristics and outcomes of CCC in the U.S.-based Congenital Cardiac Catheterization Project on Outcomes (C3PO) and the International Quality Improvement Collaborative—Congenital Heart Disease Catheterization Registry (IQIC-CHDCR) from LMICs.

The analysis included all CCC procedures recorded in C3PO (19 sites) and IQIC-CHDCR (19 sites) from 2019 to 2022. Patient and procedural characteristics, resource utilization, and outcomes were compared.

A total of 28,957 C3PO and 6,485 IQIC-CHDCR cases were analyzed. Single ventricle patients accounted for 30% of C3PO and 13% of International Quality Improvement Collaborative (IQIC), with high-risk procedures (procedural risk in congenital cardiac catheterization 3-5) performed more frequently in C3PO (42% vs 23%). Median procedure duration was longer in C3PO (1.5 vs 0.8 hours). Clinically meaningful adverse event (CMAE) rates were higher in C3PO (3.9% vs 1.5%), though mortality was comparable (0.5% vs 0.7%). Risk-adjusted analysis showed a lower ratio in IQIC for both CMAE (0.50; 95% CI: 0.39-0.62) and severity level 4/5 events (0.71; 95% CI: 0.52-0.96). However, failure-to-rescue rates were higher in IQIC (7.1% vs 2.1%).

The harmonized databases facilitated direct comparison of CCC practices, revealing more complex patients and resource-intensive procedures in C3PO, while the IQIC cohort demonstrated lower CMAE rates but a slightly higher mortality rate. These findings emphasize the need for further risk adjustment modeling for LMICs and identify areas to enhance global resource access and patient outcomes.

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