Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification System
Background American Heart Association and American College of Cardiology consensus guidelines introduce an adult congenital heart disease anatomic and physiological (AP) classification system. We assessed the association between AP classification and clinical outcomes. Methods and Results Data were...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.021345 |
| _version_ | 1797838395067596800 |
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| author | Cara L. Lachtrupp Anne Marie Valente Michelle Gurvitz Michael J. Landzberg Sarah B. Brainard Fred M. Wu Dorothy D. Pearson Keith Taillie Alexander R. Opotowsky |
| author_facet | Cara L. Lachtrupp Anne Marie Valente Michelle Gurvitz Michael J. Landzberg Sarah B. Brainard Fred M. Wu Dorothy D. Pearson Keith Taillie Alexander R. Opotowsky |
| author_sort | Cara L. Lachtrupp |
| collection | DOAJ |
| description | Background American Heart Association and American College of Cardiology consensus guidelines introduce an adult congenital heart disease anatomic and physiological (AP) classification system. We assessed the association between AP classification and clinical outcomes. Methods and Results Data were collected for 1000 outpatients with ACHD prospectively enrolled between 2012 and 2019. AP classification was assigned based on consensus definitions. Primary outcomes were (1) all‐cause mortality and (2) a composite of all‐cause mortality or nonelective cardiovascular hospitalization. Cox regression models were developed for AP classification, each component variable, and additional clinical models. Discrimination was assessed using the Harrell C statistic. Over a median follow‐up of 2.5 years (1.4–3.9 years), the composite outcome occurred in 185 participants, including 49 deaths. Moderately or severely complex anatomic class (class II/III) and severe physiological stage (stage D) had increased risk of the composite outcome (AP class IID and IIID hazard ratio, 4.46 and 3.73, respectively, versus IIC). AP classification discriminated moderately between patients who did and did not suffer the composite outcome (C statistic, 0.69 [95% CI, 0.67–0.71]), similar to New York Heart Association functional class and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide); it was more strongly associated with mortality (C statistic, 0.81 [95% CI, 0.78–0.84]), as were NT‐proBNP and functional class. A model with AP class and NT‐proBNP provided the strongest discrimination for the composite outcome (C statistic, 0.73 [95% CI, 0.71–0.75]) and mortality (C statistic, 0.85 [95% CI, 0.82–0.88]). Conclusions The addition of physiological stage modestly improves the discriminative ability of a purely anatomic classification, but simpler approaches offer equivalent prognostic information. The AP system may be improved by addition of key variables, such as circulating biomarkers, and by avoiding categorization of continuous variables. |
| first_indexed | 2024-04-09T15:40:10Z |
| format | Article |
| id | doaj.art-b87f7e53e0da4c429472df565c470d48 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T15:40:10Z |
| publishDate | 2021-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-b87f7e53e0da4c429472df565c470d482023-04-27T11:12:17ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-09-01101810.1161/JAHA.120.021345Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification SystemCara L. Lachtrupp0Anne Marie Valente1Michelle Gurvitz2Michael J. Landzberg3Sarah B. Brainard4Fred M. Wu5Dorothy D. Pearson6Keith Taillie7Alexander R. Opotowsky8Department of Cardiology Boston Children's Hospital Boston MADepartment of Cardiology Boston Children's Hospital Boston MADepartment of Cardiology Boston Children's Hospital Boston MADepartment of Cardiology Boston Children's Hospital Boston MADepartment of Cardiology Boston Children's Hospital Boston MADepartment of Cardiology Boston Children's Hospital Boston MADepartment of Cardiology Boston Children's Hospital Boston MADepartment of Cardiology Boston Children's Hospital Boston MADepartment of Cardiology Boston Children's Hospital Boston MABackground American Heart Association and American College of Cardiology consensus guidelines introduce an adult congenital heart disease anatomic and physiological (AP) classification system. We assessed the association between AP classification and clinical outcomes. Methods and Results Data were collected for 1000 outpatients with ACHD prospectively enrolled between 2012 and 2019. AP classification was assigned based on consensus definitions. Primary outcomes were (1) all‐cause mortality and (2) a composite of all‐cause mortality or nonelective cardiovascular hospitalization. Cox regression models were developed for AP classification, each component variable, and additional clinical models. Discrimination was assessed using the Harrell C statistic. Over a median follow‐up of 2.5 years (1.4–3.9 years), the composite outcome occurred in 185 participants, including 49 deaths. Moderately or severely complex anatomic class (class II/III) and severe physiological stage (stage D) had increased risk of the composite outcome (AP class IID and IIID hazard ratio, 4.46 and 3.73, respectively, versus IIC). AP classification discriminated moderately between patients who did and did not suffer the composite outcome (C statistic, 0.69 [95% CI, 0.67–0.71]), similar to New York Heart Association functional class and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide); it was more strongly associated with mortality (C statistic, 0.81 [95% CI, 0.78–0.84]), as were NT‐proBNP and functional class. A model with AP class and NT‐proBNP provided the strongest discrimination for the composite outcome (C statistic, 0.73 [95% CI, 0.71–0.75]) and mortality (C statistic, 0.85 [95% CI, 0.82–0.88]). Conclusions The addition of physiological stage modestly improves the discriminative ability of a purely anatomic classification, but simpler approaches offer equivalent prognostic information. The AP system may be improved by addition of key variables, such as circulating biomarkers, and by avoiding categorization of continuous variables.https://www.ahajournals.org/doi/10.1161/JAHA.120.021345adult congenital heart diseaseclassificationcohort studycongenital heart diseaseguidelinesmortality |
| spellingShingle | Cara L. Lachtrupp Anne Marie Valente Michelle Gurvitz Michael J. Landzberg Sarah B. Brainard Fred M. Wu Dorothy D. Pearson Keith Taillie Alexander R. Opotowsky Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification System Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adult congenital heart disease classification cohort study congenital heart disease guidelines mortality |
| title | Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification System |
| title_full | Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification System |
| title_fullStr | Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification System |
| title_full_unstemmed | Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification System |
| title_short | Associations Between Clinical Outcomes and a Recently Proposed Adult Congenital Heart Disease Anatomic and Physiological Classification System |
| title_sort | associations between clinical outcomes and a recently proposed adult congenital heart disease anatomic and physiological classification system |
| topic | adult congenital heart disease classification cohort study congenital heart disease guidelines mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.021345 |
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