Cardiac Rehabilitation and Adverse Events Among Adult Patients with Simple Congenital Heart Disease and Heart Failure

Aims Improved care has resulted in prolonged survival of patients with congenital heart disease (ConHD), increasing age-related cardiovascular comorbidities. Although cardiovascular rehabilitation (CR) represents evidence-based care for heart failure (HF), the clinical impact of CR in patients with ConHD who developed HF during adulthood is unclear. We investigated 12-month mortality and morbidity in patients with simple ConHD diagnosed with HF with CR versus without CR. Methods A retrospective cohort study was conducted for the time period February 2004 - February 2024. Utilizing TriNetX, a global federated health research network, a real-world dataset of simple ConHD patients was acquired to compare patients with vs. without (controls) prescription for exercise-based CR. Patients were propensity-score matched for age, sex, ethnicity, comorbidities, procedures, and medication. The primary outcome was a composite of all-cause mortality, ischemic stroke, and acute coronary syndrome (major adverse cardiovascular events; MACE) within 12 months. Results Following propensity score matching, the total cohort consisted of 6,866 simple ConHD patients with HF. CR was associated with significantly lower odds for MACE (odds ratio (OR) 0.61 [95% confidence interval (CI): 0.54–0.69]) and its individual components all-cause mortality (OR 0.40 [95% CI 0.33–0.47]) and ischemic stroke (OR 0.75 [95% CI 0.64–0.88]), but not acute coronary syndrome (OR 1.24 [95% CI 0.91–1.69]). Conclusion CR was associated with significantly lower 12-month MACE in patients with simple ConHD with concomitant HF compared to usual care.