Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart Disease
Background: Adverse childhood experiences (ACEs) are linked with poor physical and psychosocial health outcomes in adulthood, including cardiovascular disease. Objectives: The purpose of this study was to evaluate associations between ACEs and cardiovascular outcomes in adult congenital heart diseas...
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Elsevier
2025-06-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25002273 |
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| author | David J. Harrison, MD Rania A. Mekary, PhD, MS, MSc Shilpa Vijayakumar, MD Erin Lake, ScD, MS Joseph Kay, MD Roni M. Jacobsen, MD Camila Londono-Obregon, MD Elizabeth Yeung, MD Sarah Kelly, PsyD Ann Poteet, NP, MS Michael J. Landzberg, MD Molly Wallrich, RN Amber D. Khanna, MD |
| author_facet | David J. Harrison, MD Rania A. Mekary, PhD, MS, MSc Shilpa Vijayakumar, MD Erin Lake, ScD, MS Joseph Kay, MD Roni M. Jacobsen, MD Camila Londono-Obregon, MD Elizabeth Yeung, MD Sarah Kelly, PsyD Ann Poteet, NP, MS Michael J. Landzberg, MD Molly Wallrich, RN Amber D. Khanna, MD |
| author_sort | David J. Harrison, MD |
| collection | DOAJ |
| description | Background: Adverse childhood experiences (ACEs) are linked with poor physical and psychosocial health outcomes in adulthood, including cardiovascular disease. Objectives: The purpose of this study was to evaluate associations between ACEs and cardiovascular outcomes in adult congenital heart disease (ACHD). Methods: 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. Results: 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). Conclusions: 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. |
| format | Article |
| id | doaj-art-c4ec6cb51ce84a0f9a02e2ff99ffdf48 |
| institution | OA Journals |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-c4ec6cb51ce84a0f9a02e2ff99ffdf482025-08-20T02:31:54ZengElsevierJACC: Advances2772-963X2025-06-014610180910.1016/j.jacadv.2025.101809Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart DiseaseDavid J. Harrison, MD0Rania A. Mekary, PhD, MS, MSc1Shilpa Vijayakumar, MD2Erin Lake, ScD, MS3Joseph Kay, MD4Roni M. Jacobsen, MD5Camila Londono-Obregon, MD6Elizabeth Yeung, MD7Sarah Kelly, PsyD8Ann Poteet, NP, MS9Michael J. Landzberg, MD10Molly Wallrich, RN11Amber D. Khanna, MD12Boston Children's Hospital Cardiovascular Intensive Care Unit, Boston, Massachusetts, USA; University of Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, Aurora, Colorado, USA; Dartmouth-Hitchcock Adult Congenital Heart Disease Program, Lebanon, New Hampshire, USA; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Address for correspondence: Dr David J. Harrison, Department of Cardiology, Boston Children's Hospital, 330 Longwood Avenue, Boston, Massachusetts 02114, USA.Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USAHarvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USAHarvard T.H. Chan School of Public Health, Boston, Massachusetts, USAUniversity of Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, Aurora, Colorado, USAUniversity of Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, Aurora, Colorado, USAUniversity of Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, Aurora, Colorado, USAUniversity of Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, Aurora, Colorado, USAUniversity of Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, Aurora, Colorado, USAUniversity of Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, Aurora, Colorado, USABoston Adult Congenital Heart (B.A.C.H.) Program, Boston Children's Hospital, Boston, Massachusetts, USAUniversity of Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, Aurora, Colorado, USAUniversity of Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program, Aurora, Colorado, USABackground: Adverse childhood experiences (ACEs) are linked with poor physical and psychosocial health outcomes in adulthood, including cardiovascular disease. Objectives: The purpose of this study was to evaluate associations between ACEs and cardiovascular outcomes in adult congenital heart disease (ACHD). Methods: 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. Results: 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). Conclusions: 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.http://www.sciencedirect.com/science/article/pii/S2772963X25002273ACHDadult congenital heart diseaseadverse childhood experiencespsychosocial outcomesquality of liferisk factors |
| spellingShingle | David J. Harrison, MD Rania A. Mekary, PhD, MS, MSc Shilpa Vijayakumar, MD Erin Lake, ScD, MS Joseph Kay, MD Roni M. Jacobsen, MD Camila Londono-Obregon, MD Elizabeth Yeung, MD Sarah Kelly, PsyD Ann Poteet, NP, MS Michael J. Landzberg, MD Molly Wallrich, RN Amber D. Khanna, MD Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart Disease JACC: Advances ACHD adult congenital heart disease adverse childhood experiences psychosocial outcomes quality of life risk factors |
| title | Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart Disease |
| title_full | Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart Disease |
| title_fullStr | Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart Disease |
| title_full_unstemmed | Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart Disease |
| title_short | Adverse Childhood Experiences and Cardiovascular Outcomes in Adult Congenital Heart Disease |
| title_sort | adverse childhood experiences and cardiovascular outcomes in adult congenital heart disease |
| topic | ACHD adult congenital heart disease adverse childhood experiences psychosocial outcomes quality of life risk factors |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25002273 |
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