(357) Self-assessment of complexity and risk for pregnant adults with congenital heart disease.

Objective: Elucidate the degree to which patient risk self-assessment correlates with anatomic and physiologic class and CARPREG-II score in the setting of pregnancy and adult congenital heart disease (ACHD).

Study Design: Patients with ACHD with new Cardio-Obstetric consultation were invited to complete a pre-visit self-assessment. The survey queried ACHD complexity, physical activity limitations, rating of overall health, and prior counseling. Patients selected factors that increase pregnancy risk for people with ACHD and identified their level of risk for outcomes like heart failure, arrhythmia, stroke, cardiac arrest, or death. Basic demographic information was collected. Correlation of self-assessed risk was compared to ACHD anatomic and physiologic class and CARPREG-II scores.

Results: 41 patients were reviewed. Only 26% had entirely concordant self-assessment of ACHD complexity, functional status, and ACHD-related pregnancy risk. 31% felt their ACHD was less complex than their anatomic class, 14% more complex. Patient self-assessment of functional status correlated with ACHD physiologic class in only 56%. 84% of patients with a low/medium risk of complications based on CARPREG-II correctly identified this level. Of the 3 patients with a CARPREG-II score >4, only one correctly identified that they were at high risk for cardiac complications.

Conclusion: Only 1 in 4 pregnant patients’ pre-visit self-assessment of ACHD complexity, functional status, and risk for complications matched physician assessment. When patients misestimated anatomic class, they tended to think disease was less complex. Physiologic class, which is partially based on imaging findings, was a poor predictor of self-assessed functional status. We anticipate NYHA class would more closely match patient self-assessment. Of the highest risk patients in our cohort, 2/3 were unaware they were at high risk for complication, highlighting the critical nature of preconception counseling for patients with ACHD. Further analysis will identify factors associated with inaccurate patient risk assessment and examine pregnancy outcomes.