P2.004: Influence of Social Determinants of Health on Cardiovascular And Arrhythmic Outcomes in Pediatric Patients with Left to Right Shunts

Background: Children with congenital heart defects, such as Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), Atrioventricular Septal Defect (AVSD), and Patent Ductus Arteriosus (PDA), are at an increased risk of various cardiovascular and arrhythmic complications. Although medical advancements have improved their survival rates and quality of life, a gap remains in understanding how social determinants of health (SDOH) influence their outcomes. This study aims to examine the impact of SDOH on cardiovascular and arrhythmic outcomes in pediatric patients with left-to-right shunts, clarifying how these factors may affect their health trajectory and inform future interventions.

Methods: We queried the TriNetX US Collaborative Network for patients aged 18 years or younger diagnosed with VSD, ASD, AVSD, and PDA from January 2007 to December 2022. The patients were categorized into two cohorts: those diagnosed with potential health risks related to socioeconomic and psychosocial factors and those without the diagnosis. Propensity score matching for demographics, comorbidities, history of cardiac procedures, medication use, BMI, and lab values resulted in 8,578 patients in each cohort. The primary outcome was a composite measure of all-cause mortality, supraventricular and ventricular arrhythmias. Secondary outcomes included atrial and ventricular arrhythmias, stroke, sinus node dysfunction, heart failure, all-cause mortality, acute pulmonary edema, ICU admission, acute kidney injury (AKI), and AV block. Cox proportional hazard ratios were utilized to compare outcomes over a 2-year follow-up period.

Results: The cohort diagnosed with potential health hazards related to socioeconomic and psychosocial circumstances was associated with a significantly reduced risk of the primary composite outcome (HR 0.810; 95% CI: 0.720-0.910, p< 0.0001). This cohort was also linked to lower risks of secondary outcomes, including SVT (HR 0.407; 95% CI: 0.307-0.540, p< 0.0001), sinus node dysfunction (HR 0.465; 95% CI: 0.256-0.844, p< 0.010), heart failure (HR 0.349; 95% CI: 0.291-0.418, p< 0.0001), acute pulmonary edema (HR 0.563; 95% CI: 0.429-0.738, p< 0.0001), ICU admission (HR 0.696; 95% CI: 0.597-0.811, p< 0.0001), and AV block (HR 0.485; 95% CI: 0.352-0.669, p< 0.0001). However, this cohort was associated with a significantly higher risk of hemorrhagic stroke (HR 1.710; 95% CI: 1.212-2.413, p< 0.002) and all-cause mortality (HR 1.272; 95% CI: 1.056-1.532, p< 0.011). No significant difference was seen in the risk of atrial fibrillation and flutter, ischemic stroke, cardiac arrest, or AKI between the two cohorts.

Conclusion: Our study reveals that children with potential health hazards related to socioeconomic and psychosocial factors were unexpectedly associated with a significantly reduced risk of adverse cardiovascular outcomes, including heart failure, SVT, and ICU admissions. These findings suggest the possibility of under-diagnosis within this cohort, where limited detection of cardiovascular conditions could lead to an underestimation of actual health risks. Further research is necessary to determine whether under-diagnosis contributes to these unexpected results.