Prevalence of Coronary Artery Disease, Risk Factors and Implications on Healthcare Services Utilization in a Large Cohort of Adults with Congenital Heart Disease in Israel

Yonatan Buber ^1,8 Leonard Blieden ^2,8 Alexandeer Dadashev ^2,8 Rafael Hirsh ^2,8 Ofra Kalter-Leibovici ^3,8 Avraham Lorber ^4,9 Amiram Nir ^5,10 Sergei Yalonetsky ^4,9 Gabriel Chodick ⁶ Dalia Weitzman ⁶ Ran Balicer ⁷ Michal Benderly ^3,8

¹Cardiology, Sheba Medical Center, Ramat Gan
²Cardiology, Rabin Medical Center, Petach Tikva
³Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan
⁴Pediatric Cardiology and GUCH Unit, Rambam healthcare campus, Haifa
⁵Department of Pediatric Cardiology, Hadassah medical center, Jerusalem
⁶Medical division, Maccabi Healthcare Services
⁷Clalit Research Institute, Clalit health services
⁸Sackler Faculty of Health, Tel Aviv University, Tel Aviv
⁹Faculty of Medicine, Technion, Haifa
¹⁰Faculty of medicine, Hebrew university, Jerusalem

Background: Coronary artery disease (CAD) and associated risk factors (RF) are common among adults with congenital heart disease (ACHD), especially in those with specific lesions. The estimated prevalence of these comorbidities and the associated healthcare services utilization are not well characterized.

Methods: Data on CAD and RF`s were obtained for 15,158 ACHD patients (Age≥18 years) identified by coded diagnoses and specific procedures in medical records of the two largest health maintenance organizations (HMO`s). For patients with multiple heart defects, the most severe defect was considered as the main diagnosis. Outpatient clinic visits, emergency department (ED) visits and hospital admissions were recorded.

Results: Mean age was 50+19 years. The most common defect was secundum atrial septal defect (ASD, n=3327, 26%). Overall, 8317 patients (55%) had any of the three RF’s examined, the most common being hyperlipidemia (47%), followed by hypertension (HTN; 31%) and diabetes mellitus (DM; 11%). CAD was recorded in 2304 patients (15%). After adjustment for age, HTN and hyperlipidemia were most common among individuals with native aortic anomalies (43% and 47%, respectively; p

Conclusions: The prevalence of both CAD and associated RF’s are high among Israeli ACHD patients and is associated with augmented utilization of healthcare services.