Adults with Down syndrome (DS) represent a distinct subgroup among patients hospitalized with congenital heart disease (CHD), with differences in comorbidities, procedural care, and in-hospital outcomes. A retrospective cohort study published in the International Journal of Cardiology: Congenital Heart Disease analyzed data from the 2016-2022 National Inpatient Sample, including adults aged 18-64 years with CHD, to evaluate admission trends, management, and outcomes stratified by DS status. 

The primary outcome was in-hospital mortality. The primary outcome was in-hospital mortality, while secondary endpoints included temporal trends in admissions, cardiac procedure utilization, and length of stay. 

Among an estimated 54,410 CHD hospitalizations, 3,745 patients (6.9%) had a diagnosis of DS. Over the study period, overall CHD admissions increased (nptrend < 0.05), while the proportion involving DS remained stable, ranging from 6.6% in 2016 to 6.2% in 2022 (nptrend = 0.23).

Patients with DS more commonly had hypothyroidism, dementia, and chronic obstructive pulmonary disease (all p < 0.05). Cardiac procedures were performed less frequently in patients with DS compared with those without DS (7.6% vs 23.2%; p < 0.001).

After adjustment, DS remained associated with higher in-hospital mortality (adjusted odds ratio [AOR] 2.00; 95% CI 1.40-2.88; p < 0.001). Adults with DS and CHD represent a clinically vulnerable population with higher in-hospital mortality and lower procedural utilization. These findings underscore the need for dedicated care pathways to improve outcomes during hospitalization.