Overweight and Obesity in Operated and Unoperated Adults with Congenital Heart Disease and Heart Failure (ACHD-HF)

Background: Obesity is an escalating global health problem, particularly affecting adults with congenital heart disease (ACHD), where heart failure (HF) is a major cause of morbidity and mortality. The interaction between preexisting cardiac abnormalities and the metabolic burden imposed by obesity or overweight is clinically important. This study aims to provide real-world insights into overweight and obesity within a large cohort of ACHD, both operated and non-operated.

Methods: The Pathfinder-CHD Registry, initiated in Germany in 2022, is a prospective, web-based observational registry focused on HF in ACHD. It collects detailed clinical data, body mass index (BMI), with obesity defined as BMI ≥30 kg/m² and overweight as BMI 25–29.9 kg/m². Differences between groups were analyzed by ANOVA, with p < 0.05 considered significant.

Results: Since November 2022, 1,420 patients (mean age 37.7 ± 12.4 years; 47.3% female) were enrolled in the registry. 639 patients (45.0%) were overweight or obese. Significant differences in BMI and overweight were found between the CHD groups. Patients with posttricuspid shunts (132) had a significantly higher BMI (27.9 ± 6.7 kg/m²) and prevalence of obesity (53.0%) compared with 580 patients with complex CHD (BMI: 24.8 ± 4.5 kg/m²; obesity prevalence: 44.0%) and 313 patients with right-sided CHD (BMI: 25.1 ± 5.0 kg/m²; obesity prevalence: 48.8%) (p < 0.001). No significant difference was observed between 157 patients with left-sided CHD (BMI: 25.6 ± 4.3 kg/m²; obesity prevalence: 51.6%) and other groups. 65.7% of the obese patients had a history of previous reparative or palliative cardiac surgery, while 18.6% had had interventional CHD treatment and 13.6% a native CHD. Notably, a total of 343 (53.7%) patients with history of cyanosis were obese.

Conclusion: Obesity and overweight in ACHD with HF are often underestimated in their potential to develop cardiovascular complications. The Pathfinder Registry provides novel data on the relationship between weight issues and medical, surgical, and/or interventional treatment of the underlying CHD. The findings highlight the need for personalized, evidence-based counseling and treatment including the long-term data, which are crucial for a better understanding of the impact of HF in these patients.

Publication History

Article published online:
11 February 2025