O2057: Effect of Social Determinants of Health on Exercise Capacity in Patients with Congenital Heart Disease

Background: Health outcomes in patients with congenital heart disease (CHD) are affected by social determinants of health (SDoH). Exercise capacity has also been shown to impact outcomes in CHD. Research into the potential effects of SDoH on exercise capacity in CHD is needed to better understand how environmental and societal factors play into these important relationships. We evaluated the effect of SDoH on exercise capacity in patients with CHD.

Methods: A retrospective analysis of exercise capacity was conducted on CHD patients ≤ 18 years of age. We utilized only maximal effort (respiratory exchange ratio ≥ 1.10) cardiopulmonary exercise tests (CPETs). Patients were divided into three groups based on native cardiac anatomy: single ventricle (n=83), complex two-ventricle (n=182), and simple two-ventricle (n=223). The census block Child Opportunity Index 2.0 (COI) was used as a marker of SDoH. Each cardiac anatomy cohort was divided into five COI percentiles (%ile): very low ( < 20th %ile), low (20th to < 40th %ile), moderate (40th to < 60th %ile), high (60th to < 80th %ile), and very high (≥80th %ile). Demographic, anthropometric, and CPET parameters—including resting heart rate (HR), maximal HR, HR reserve, peak oxygen uptake (VO2peak), and exercise duration—were compared across COI levels within each cardiac anatomy group. Assessment of the effect of COI on CPET parameters was performed using analysis of variance (ANOVA).

Results: Demographic characteristics varied significantly across COI levels, particularly for race/ethnicity (p < 0.001) (Table 1). In the single ventricle cohort, there was a difference in exercise duration among COI categories (p=0.041) with the highest COI group achieving the longest exercise time. For complex two-ventricle patients, VO2peak and percentage of predicted VO2peak were significantly higher in those from higher COI census blocks (p=0.001 and p=0.004, respectively) (Table 2). Exercise duration also significantly increased with COI (p < 0.001) in the complex two-ventricle cohort. In the simple two-ventricle group, higher COI groups demonstrated significantly higher VO2peak (p=0.018), percentage of predicted VO2peak (p=0.008), and exercise duration (p=0.001).

Conclusion: This study demonstrated significantly higher exercise capacity in pediatric CHD patients living in higher COI census blocks when compared to lower COI census blocks. This finding was primarily seen in the complex and simple two-ventricle groups. These findings underscore the need to consider the socioeconomic disparities that might affect our patients’ ability to maintain cardiorespiratory fitness in a way that optimizes their outcomes following major CHD surgery.