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Background: Adults with congenital heart disease (CHD) are at elevated risk of hospitalization for community-acquired pneumonia (CAP). Proton-pump inhibitors (PPIs) have been shown to be a risk factor for CAP in adult and pediatric general populations. This study explored the association between PPI use and subsequent CAP hospitalizations in the adult CHD population. Methods: Using the Danish National Patient Registry, we performed a nested case-control study of adults with CHD who had been admitted to the hospital for CAP between 1996 and 2017. The timing and dose of PPI were evaluated in the year preceding the CAP admission. Logistic regression measured the impact of timing and dose of PPI on the subsequent CAP admission. Results: In total, 618 adult CHD patients were admitted for CAP during the study period. The adjusted odds ratio (OR) was 2.21 (95% confidence interval (CI) 1.66–2.94) for CAP in current PPI users compared with non-users. The OR amongst current PPI users was further elevated for males, those older than 65 years old and those with severe/univentricular CHD [3.59 (95% CI 2.33–5.52), 2.30 (95% CI 1.55–3.41), 2.35 (95% CI 1.13–4.87)], respectively. Segmenting by dose, the OR for CAP patients taking low-dose and high-dose PPI was 2.11 (95% CI 1.38–3.22) and 2.29 (95% CI 1.60–3.26), respectively. Conclusions: Adults with CHD prescribed a PPI are at elevated risk of hospitalization for CAP in the following 90 days. The risk for CAP admission is further increased for those prescribed high-dose PPIs, males, those older than 65 years of age, and those with severe/univentricular CHD.

Background: Adults with congenital heart disease (CHD) are at increased risk for major adverse cardiovascular events (MACE), including stroke, myocardial infarctions, and heart failure. Following survival of MACE, an important metric is re-entry to the workforce. This study sought to characterize the differences in return-to-work (RTW) characteristics between MACE survivors with CHD and those in the general population. Methods: Linking Danish health and administrative registries, a cohort of adults with CHD who survived a MACE between the years of 1992–2017 were matched 10:1 by age at MACE, year of MACE, and sex to MACE survivors without CHD. Logistic regression assessed working status relative risk at three-, six-, and 12- months after the MACE event. Cox regression hazard ratio characterized time to RTW and maintained RTW. Results: During the study period, 538 CHD patients survived MACE. These patients were matched to 4930 MACE survivors without CHD. The adjusted odds ratios of having returned to work were 0.91 (95% confidence interval (CI): 0.73–1.14) of employment at three months, 0.77 (95% CI: 0.61–0.96) at six months, and 0.76 (95% CI: 0.61–0.96) at 12 months. Of those who required governmental disability payments after MACE and admission for longer than one day, the adjusted hazard ratio of maintained RTW was 0.83 (95% CI: 0.69–0.99) for CHD patients compared to the general population. Conclusions: Patients with CHD who survive a MACE have evidence of impaired RTW compared to those without CHD. Further research is needed to understand and augment functional recovery in this complex population.