Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart Disease: ACEs in ACHD

Adverse childhood experiences (ACEs) are linked with poor physical and psychosocial health outcomes in adulthood, including cardiovascular disease.

The purpose of this study was to evaluate associations between ACEs and cardiovascular outcomes in adult congenital heart disease (ACHD).

Outpatients with ACHD completed surveys including medical/psychosocial history, ACEs (range, 0-10), linear quality of life score (QoL, range, 0-100), and NYHA functional class (NYHA FC). Multivariable regression was performed on the exposure (ACEs score) on a binary composite outcome of self-reported heart failure, stroke, unplanned cardiac hospitalization, or emergency department visit for a cardiac cause. Secondary multivariable analyses included ACEs vs NYHA FC, and QoL score. Potential confounders included age, sex, ACHD complexity, number of prior surgeries, and mental health diagnosis.

A total of 153 respondents provided complete data. Seventy-eight percent had moderate or complex ACHD. Mean ACEs score was 2.26 ± 2.4, 41 (27%) reported ≥4 ACEs. Ninety-one (59%) met the composite outcome, of whom mean ACEs 2.68 ± 2.5. Each 1-U increase in ACEs was independently associated with 1.24 times odds of the composite outcome (95% CI: 1.04-1.49; P = 0.02), 1.19 times the cumulative odds of being in a worsened NYHA FC (95% CI: 1.03-1.37; P = 0.02), and 1.35 points lower QoL score (95% CI: -2.58 to -0.11; P = 0.03).

In ACHD, ACEs appear common and were associated with higher odds of the composite outcome of heart failure, stroke, unplanned hospitalization, or emergency department visit due to heart condition, as well as worsened NYHA FC, and a lower quality of life score.