{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T20:53:12Z","timestamp":1793047992302,"version":"4.5.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,12,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Management strategies of unplanned hospitalizations (UPH) vary and have not been well characterized in patients with Fontan circulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We prospectively followed 3226 Fontan patients for 3\u2009years to characterize the current UPH status and elucidate the associations between in\u2010hospital management strategies and postdischarge outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A total of 243 UPHs occurred (2.5 cases\/100 person\u2010years). Fontan\u2010related UPHs accounted for 154 cases (63%), most commonly due to heart failure (19%), protein\u2010losing enteropathy (16%), hemorrhage (14%), arrhythmia (9%), thromboembolism (3%), and plastic bronchitis (2%). Fontan\u2010unrelated UPHs (89 cases; 37%) were mainly due to infections (19%). Adult patients were more frequently hospitalized for hemorrhage and thromboembolism (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.05). The longest length of hospital stay was observed in protein\u2010losing enteropathy, followed by thromboembolism and heart failure. Among nonpharmacological treatments, oxygen therapy was commonly used, followed by surgical procedures and catheter\u2010based interventions. Among pharmacological treatments, diuretics were commonly administered, followed by heparin and catecholamines. Of 240 patients discharged alive, 76 (15.4 cases\/100 person\u2010years) were readmitted. Protein\u2010losing enteropathy was the most frequent cause of readmission, followed by heart failure and hemorrhage. In addition to conventional risk factors, in\u2010hospital management practices, such as oxygen therapy, surgical intervention, and diuretic adjustment were associated with readmission risk (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.01\u20130.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">We clarified real\u2010world practices related to UPHs in Fontan patients. Specific in\u2010hospital treatment strategies were associated with the risk of readmission. Further studies are warranted to determine the causal relationships between treatment approaches and outcomes for standardized management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044374","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T10:50:31Z","timestamp":1765363831000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Unplanned Hospitalization Due to All\u2010Cause Morbidity and Its Real\u2010World Management Practices in Patients With Fontan Circulation"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7092-4792","authenticated-orcid":false,"given":"Hideo","family":"Ohuchi","sequence":"first","affiliation":[{"name":"National Cerebral and Cardiovascular Center","place":["Suita, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9845-5828","authenticated-orcid":false,"given":"Kohta","family":"Takei","sequence":"additional","affiliation":[{"name":"Nagano Children\u2019s Hospital","place":["Azumino, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Muneuchi","sequence":"additional","affiliation":[{"name":"Japan Community Healthcare Organization","place":["Fukuoka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3698-4836","authenticated-orcid":false,"given":"Shingo","family":"Kasahara","sequence":"additional","affiliation":[{"name":"Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital","place":["Okayama, 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