Prognostic Value of the Anatomic-Physiologic Classification in Adults With Congenital Heart Disease
Authors' conclusion
The CHD physiologic stage can potentially be used for risk stratification, as well as to monitor disease progression and response to therapy.
Study context
- Population
- Adults with congenital heart disease, Mayo Clinic, 2003–20194,588 assessed at 36 months
- Participants
- 5,321 adults
- Exposure
- Congenital heart disease (CHD) physiologic stage added to conventional clinical risk models
- Stage An = 1,649
- Stage Bn = 1,968
- Stage Cn = 1,224
- Stage Dn = 480
- Outcome
- All-cause mortality (incremental prognostic power of CHD physiologic stage beyond conventional clinical risk models)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
All-cause mortality
Hazard ratio (95% CI)P value
Baseline CHD physiologic stage
1.13(1.09–1.17)
P < 0.001Change in CHD physiologic stage
1.46(1.32–1.61)
P = 0.007Per unit increase in stage, as printed
- C statistic, conventional clinical risk model
- 0.702 (0.681-0.724)
- C statistic, with CHD physiologic stage
- 0.769 (0.754-0.787)
Observational data: associations, not effects.
Further findings
| Outcome | Clinical stability | Clinical deterioration | Clinical improvement |
|---|---|---|---|
| Change in CHD physiologic stage at 36 months | 73% | 8% | 19% |
- Change in CHD physiologic stage at 36 months: n = 4588 with 36-month assessment
Change in CHD physiologic stage at 36 months
- Patients with clinical improvement more likely to have undergone cardiac procedures between assessments
Original publication
Prognostic Value of the Anatomic-Physiologic Classification in Adults With Congenital Heart Disease. Circ Heart Fail. Published 21 July 2023. doi:10.
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