scholarly journals US Mortality Due To Congenital Heart Disease Across the Lifespan from 1999-2017 Exposes Persistent Racial/Ethnic Disparities

2020 ◽  
Author(s):  
Keila N. Lopez ◽  
Shaine A. Morris ◽  
Kristen Sexson Tejtel ◽  
Andre Espaillat ◽  
Jason L. Salemi
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Mortality Rate ◽  
Congenital Heart ◽  
Quality Care ◽  
Temporal Trends ◽  
Ethnic Disparities ◽  
Population Estimates ◽  
All Cause Mortality ◽  
Race Ethnicity

ABSTRACTBackgroundCongenital heart disease (CHD) accounts for approximately 40% percent of deaths in United States (US) children with birth defects. Previous US data from 1999-2006 demonstrated an overall decrease in CHD mortality. The objective of our study was to assess current trends in US mortality related to CHD from infancy to adulthood over the last 19 years and determine differences by sex and race/ethnicity.MethodsWe conducted an analysis of death certificates from 1999-2017 to calculate annual CHD mortality by age at death, race/ethnicity, and sex. Population estimates used as denominators in mortality rate calculation for infants were based on National Center for Health Statistics live birth data. Mortality rates in individuals >1 year of age utilized US Census Bureau bridged-race estimates as denominators for population estimates. We characterized temporal trends in all-cause mortality, mortality resulting directly due to and related to CHD by age, race/ethnicity, and sex using joinpoint regression.ResultsThere were 47.7 million deaths with 1 in 814 deaths due to CHD (n=58,599). While all-cause mortality decreased 16.4% across all ages, mortality resulting from CHD declined 39.4% overall. The mean annual decrease in CHD mortality was 2.6%, with the largest decrease for those age >65years. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100,000. Males had higher mortality due to CHD than females throughout the study, although both sexes declined at a similar rate (∼40% overall), with a 3-4% annual decrease between 1999 and 2009, followed by a slower annual decrease of 1.4% through 2017. Mortality resulting from CHD significantly declined among all race/ethnicities studied, although disparities in mortality persisted for non-Hispanic Blacks versus non-Hispanic Whites (mean annual decrease 2.3% versus 2.6%, respectively; age-adjusted mortality rate 1.67 to 1.05 versus 1.35 to 0.80 per 100,000, respectively).ConclusionsWhile overall US mortality due to CHD has decreased over the last 19 years, disparities in mortality persist for males compared to females and for non-Hispanic Blacks compared to non-Hispanic Whites. Determining factors that contribute to these disparities such as access to quality care, timely diagnosis, and maintenance of insurance will be important moving into the next decade.

scholarly journals US Mortality Attributable to Congenital Heart Disease Across the Lifespan From 1999 Through 2017 Exposes Persistent Racial/Ethnic Disparities

Circulation ◽  
2020 ◽  
Vol 142 (12) ◽  
pp. 1132-1147
Author(s):  
Keila N. Lopez ◽  
Shaine A. Morris ◽  
S. Kristen Sexson Tejtel ◽  
Andre Espaillat ◽  
Jason L. Salemi
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Mortality Rate ◽  
Congenital Heart ◽  
Temporal Trends ◽  
Ethnic Disparities ◽  
Population Estimates ◽  
The Past ◽  
All Cause Mortality ◽  
Race Ethnicity

Background: Congenital heart disease (CHD) accounts for ≈40% of deaths in US children with birth defects. Previous US data from 1999 to 2006 demonstrated an overall decrease in CHD mortality. Our study aimed to assess current trends in US mortality related to CHD from infancy to adulthood over the past 19 years and determine differences by sex and race/ethnicity. Methods: We conducted an analysis of death certificates from 1999 to 2017 to calculate annual CHD mortality by age at death, race/ethnicity, and sex. Population estimates used as denominators in mortality rate calculations for infants were based on National Center for Health Statistics live birth data. Mortality rates in individuals ≥1 year of age used US Census Bureau bridged-race population estimates as denominators. We used joinpoint regression to characterize temporal trends in all-cause mortality, mortality resulting directly attributable to and related to CHD by age, race/ethnicity, and sex. Results: There were 47.7 million deaths with 1 in 814 deaths attributable to CHD (n=58 599). Although all-cause mortality decreased 16.4% across all ages, mortality resulting from CHD declined 39.4% overall. The mean annual decrease in CHD mortality was 2.6%, with the largest decrease for those >65 years of age. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100 000. Males had higher mortality attributable to CHD than females throughout the study, although both sexes declined at a similar rate (≈40% overall), with a 3% to 4% annual decrease between 1999 and 2009, followed by a slower annual decrease of 1.4% through 2017. Mortality resulting from CHD significantly declined among all races/ethnicities studied, although disparities in mortality persisted for non-Hispanic Blacks versus non-Hispanic Whites (mean annual decrease 2.3% versus 2.6%, respectively; age-adjusted mortality rate 1.67 to 1.05 versus 1.35 to 0.80 per 100 000, respectively). Conclusions: Although overall US mortality attributable to CHD has decreased over the past 19 years, disparities in mortality persist for males in comparison with females and for non-Hispanic Blacks in comparison with non-Hispanic Whites. Determining factors that contribute to these disparities such as access to quality care, timely diagnosis, and maintenance of insurance will be important moving into the next decade.

Decreasing mortality in patients with simple congenital heart disease: a Danish nationwide study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M El-Chouli ◽  
M Malmborg ◽  
C.N.F Bang ◽  
G.H Gislason
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Septal Defect ◽  
Ductus Arteriosus ◽  
Pulmonary Stenosis ◽  
Temporal Trends ◽  
Funding Source ◽  
All Cause Mortality ◽  
Over Time

Abstract Background The long-term mortality in patients with simple congenital heart disease (SCHD) compared with the general population is not well-described. Purpose To investigate the 10-year mortality in individuals with and without SCHD and whether it has changed since 1977 using contemporary data. Method By linking Danish nationwide registries, we identified all individuals with and without a SCHD diagnosis who were alive at age 40 between 1977–2006. Excluded were individuals with moderate or severe congenital heart disease. SCHD was defined as isolated ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA) or pulmonary stenosis (PS). The population was followed from age 40 until death or emigration, whichever came first. We predicted 10-year all-cause mortality according to each year of inclusion. Reported was 10-year all-cause mortality and mortality ratios (SCHD vs non-SCHD) with 95% confidence intervals (CI) by calendar year groups (1977–1986, 1987–1996, 1997–2006). Results We identified 2,040 individuals with SCHD (VSD: 27.5%, ASD: 62.2%, PDA 6.8%, PS: 3.5%), of which 1,121 (55.0%) were female, and 2,083,277 individuals without SCHD, of which 1,028,769 (49.4%) were female. In individuals with SCHD the 10-year all-cause mortality decreased over time in both men (1977–1986: 12.3% [11.8–12.9%], 1987–1996: 9.0% [7.4–10.5%], 1997–2006: 5.0% [4.3–5.7%]) and women (1977–1986: 7.7% [7.5–7.9%], 1987–1996: 4.9% [3.9–6.0%], 1997–2006: 1.2% [0.7–1.7%]), whereas the 10-year risks were somewhat stable in individuals without SCHD for both men (1977–1986: 3.2% [3.2–3.2%], 1987–1996: 3.3% [3.2–3.3%], 1997–2006: 2.9% [2.7–3.0%]) and women (1977–1986: 2.4% [2.3–2.4%], 1987–1996: 2.1% [2.1– 2.2%], 1997–2006: 1.7% [1.6–1.8%]) (Figure 1, panel A). The mortality ratio decreased over time in both men (1977–1986: 3.9 [3.7–4.1], 1987–1996: 2.7 [2.3–3.2], 1997–2006: 1.7 [1.5–1.9]) and women (1977–1986: 3.3 [3.2–3.3], 1987–1996: 2.3 [1.8– 2.7], 1997–2006: 0.7 [0.4–1.0]) (Figure 1, panel B) remaining significantly higher for men, but not women, in 1997–2006. Conclusion In individuals with simple congenital heart disease aged 40 years, the 10-year mortality decreased dramatically over time for both men and women. Despite decreasing mortality, men with SCHD, but not women, remained at a higher 10-year mortality compared to individuals without SCHD. Figure 1. Temporal trends in 10-year mortality Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Danish Heart Foundation

scholarly journals Pulmonary Arterial Hypertension Associated with Congenital Heart Disease in Adults over the Age of 40 Years

2020 ◽  
Vol 9 (12) ◽  
pp. 4071
Author(s):  
Susanne J. Maurer ◽  
Katharina Stöckemann ◽  
Claudia Pujol ◽  
Jürgen Hörer ◽  
Peter Ewert ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Univariate Analysis ◽  
All Cause Mortality ◽  
Pulmonary Arterial ◽  
Significant Mortality

Background: Pulmonary arterial hypertension associated with adult congenital heart disease (PAH-ACHD) leads to significant mortality at a young age. Risk factors for a negative outcome in older adults are lacking. Methods: PAH-ACHD patients ≥ 40 years of age under active follow-up between January 2005 and December 2018 were included. Demographic data, as well as medical/surgical history, were retrieved from hospital records. The primary end-point was all-cause mortality. Results: In total, 65 patients (67.7% female, mean age 45.19 ± 6.75 years) were included. Out of these, 46 (70.8%) had a shunt lesion, 12 (18.5%) had PAH associated with complex congenital heart defects, and 7 (10.8%) had segmental pulmonary hypertension due to major aorto-pulmonary collaterals. Down syndrome was present in 13 patients (20.0%). During a median follow-up of 4.2 years (IQR 1.2–7.5), 16 patients (24.6%) died. On univariate analysis, NT-proBNP (log), creatinine, and a previous history of ventricular arrhythmias were predictors of all-cause mortality. Upon multivariate analysis, NT-proBNP (log) (HR: 4.1, 95% CI: 1.2–14.4, p = 0.029) and creatinine (HR: 16.3, 95% CI: 2.2–118.7, p = 0.006) remained as independent predictors of all-cause mortality. Conclusions: PAH-ACHD patients over the age of 40 years are burdened with significant mortality, of which NT-proBNP and creatinine are independent predictors.

scholarly journals 2316. RSV Mortality: 19 Years’ Experience in a Pediatric Hospital in Argentina

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S794-S794
Author(s):  
Angela Gentile ◽  
Maria Florencia Lucion ◽  
María del Valle Juárez ◽  
María Soledad Areso ◽  
Lucia Paglieri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Mortality Rate ◽  
Neurological Disease ◽  
Congenital Heart ◽  
Acute Lower Respiratory Infection ◽  
Significant Difference ◽  
Rsv Infection ◽  
Epidemiological Characteristics

Abstract Background Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection (ALRI) in children. We aimed to describe the clinical–epidemiological pattern and risk factors for mortality associated with RSV infection. Methods Prospective, cross-sectional study of ALRI in children admitted to a Children’s Hospital among 2000–2018. Viral diagnosis was made by fluorescent antibody techniques or real-time PCR. We compared clinical–epidemiological characteristics of RSV infection in nonfatal vs. fatal cases. Multiple logistic regression was used to identify independent predictors of mortality. Results From a total 16,018 patients with ALRI, 13,545(84.6%) were tested for respiratory viruses, 6047 (45%) were positive: RSV 81.1% (4,907), influenza 7.5% (456), parainfluenza 6.9% (419) and adenovirus 4.4% (265). RSV had a seasonal epidemic pattern coinciding with months of lowest average temperature. RSV mortality rate: 1.7% (83/4,855). Fatal cases had a higher proportion of: prematurity (P < 0.01), perinatal respiratory history (P < 0.01), malnourishment (P < 0.01), congenital heart disease (P < 0.01), chronic neurological disease (P < 0.01) and pneumonia as clinical presentation (<0.01). No significant difference between gender was observed. The annual mortality rate distribution was not stable over the study period with the highest mortality in the year 2002. Most deaths occurred among children who had complications: respiratory distress (80.7%), sepsis (31.3%) and atelectasis (13.2%). Independent predictors of RSV mortality were: moderate to severe malnourishment OR 3.64 (95% CI 1.96–6.74)P < 0.01, chronic neurological disease OR 3.99 (95% CI 2.04–7.79) P < 0.01, congenital heart disease OR 4.10 (95% CI 2.36–7.15)P < 0.01 and age under 6 months OR 1.96 (95% CI 1.23–3.11)P < 0.01. Conclusion RSV showed an epidemic seasonal pattern. Malnourishment, chronic neurological disease, congenital heart disease, age under 6 months and pneumonia were the independent risk factors for RSV mortality. Disclosures All authors: No reported disclosures.

scholarly journals Severe pulmonary hypertension and reduced right ventricle systolic function associated with maternal mortality in pregnant uncorrected congenital heart diseases

2019 ◽  
Vol 9 (4) ◽  
pp. 204589401988451 ◽  
Author(s):  
Anggoro B. Hartopo ◽  
Dyah W. Anggrahini ◽  
Detty S. Nurdiati ◽  
Noriaki Emoto ◽  
Lucia K. Dinarti
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Mortality Rate ◽  
Right Ventricle ◽  
Maternal Mortality ◽  
Atrial Septal Defect ◽  
Congenital Heart ◽  
Septal Defect ◽  
Systolic Function

Background Pregnant uncorrected congenital heart disease patients, especially those who already developed pulmonary hypertension, have increased risk for maternal mortality. The pulmonary hypertension severity and right ventricle function may be associated with higher maternal mortality. The study aimed to investigate the mortality rate of pregnant uncorrected congenital heart disease and the impact of pulmonary hypertension severity on mortality. Methods This is the sub study of COngenital HeARt Disease in adult and Pulmonary Hypertension Registry. The data of pregnant uncorrected congenital heart disease patients were analyzed from registry database. The maternal mortality was recorded. The data of demography, clinics, obstetrics, and transthoracic echocardiography were collected. The factors that influenced maternal mortality were analyzed. A statistical significance was determined when p value < 0.05. Results From 2012 until 2017, there were 78 pregnant congenital heart disease patients. Of them, 56 patients were eligible for analyses. The majority of congenital heart disease was atrial septal defect (91.1%). The maternal mortality rate was 10.7% (6 of 56). Pulmonary hypertension occurred in 48 patients, therefore the maternal mortality rate among congenital heart disease-pulmonary hypertension with majority of atrial septal defect was 12.5% (6 of 48). Among nonsurvivors, 100% suffered from severe pulmonary hypertension as compared to survivors (56.0%), p = 0.041. Most nonsurvivors were Eisenmenger syndrome (83.3%), significantly higher compared to survivors (22.0%), p = 0.006. Nonsurvivors had significantly worsened WHO functional class, reduced right ventricle systolic function, and right heart failure. The modes of maternal death were severe oxygen desaturation (66.7%) and respiratory failure and sepsis (33.3%). Most of the maternal deaths occurred within 24 h postpartum period. Conclusion Maternal mortality rate among pregnant uncorrected congenital heart disease with majority of atrial septal defect was 10.7% and among congenital heart disease-pulmonary hypertension with majority of atrial septal defect was 12.5%. Factors related with maternal mortality were severe pulmonary hypertension, Eisenmenger syndrome, and reduced right ventricle systolic function.

Prognostic value of von Willebrand factor in adult patients with congenital heart disease

Heart ◽  
2020 ◽  
Vol 106 (12) ◽  
pp. 910-915 ◽  
Author(s):  
Hideo Ohuchi ◽  
Yohsuke Hayama ◽  
Hikari Miike ◽  
Dai Suzuki ◽  
Kimiko Nakajima ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Von Willebrand Factor ◽  
Plasma Levels ◽  
Prognostic Value ◽  
Congenital Heart ◽  
Arterial Oxygen ◽  
All Cause Mortality ◽  
Von Willebrand ◽  
Willebrand Factor

Objectivesvon Willebrand factor (vWF) has prognostic value in patients with heart failure (HF) and in those with liver disease. Liver congestion, due to right-sided HF (RHF), is one of the major clinical pathophysiologic manifestations in adults with congenital heart disease (ACHD). The present study’s purpose was to clarify the prognostic value of plasma levels of vWF antigen (vWF:Ag) in ACHD.MethodsWe measured vWF:Ag (%) in 382 consecutive patients (20 unrepaired cyanotic ACHD, 172 Fontan patients and 190 ACHD after biventricular repair) and compared the results with the clinical profiles and prognosis.ResultsThe plasma vWF:Ag level was 130±53 (normal range: 55%–190%), and 48 patients (13%) showed high levels of vWF:Ag (≥190%). Older age, Fontan circulation, higher central venous pressure, lower arterial oxygen saturation and lower plasma levels of albumin were independently associated with high log (vWF:Ag) (p<0.05–0.0001). During the follow-up of 2.4±1.4 years, 15 patients died. High log (vWF:Ag) predicted the all-cause mortality (HR 1.63 per 0.1, 95% CI 1.40 to 1.96, p<0.0001). Specifically, patients with high vWF:Ag (≥165%) had a substantially higher risk of all-cause mortality (HR 56.4, 95% CI 11.4 to 1020, p<0.0001), and this prognostic value was independent of plasma levels of brain-type natriuretic peptide.ConclusionsHigh vWF:Ag may reflect RHF severity and related liver dysfunction with a strong prognostic value of all-cause mortality in ACHD. Thus, vWF:Ag might be an excellent biomarker for monitoring ACHD with RHF.

scholarly journals Current use and safety of novel oral anticoagulants in adults with congenital heart disease: results of a nationwide analysis including more than 44 000 patients

2020 ◽  
Vol 41 (43) ◽  
pp. 4168-4177 ◽  
Author(s):  
Eva Freisinger ◽  
Joachim Gerß ◽  
Lena Makowski ◽  
Ursula Marschall ◽  
Holger Reinecke ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Prospective Studies ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants ◽  
All Cause Mortality ◽  
Adult Congenital

Abstract Aims  To evaluate the use of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) in adult congenital heart disease (ACHD) and assess outcome in a nationwide analysis. Methods and results  Using data from one of Germany’s largest Health Insurers, all ACHD patients treated with VKAs or NOACs were identified and changes in prescription patterns were assessed. Furthermore, the association between anticoagulation regimen and complications including mortality was studied. Between 2005 and 2018, the use of oral anticoagulants in ACHD increased from 6.3% to 12.4%. Since NOACs became available their utilization increased constantly, accounting for 45% of prescribed anticoagulants in ACHD in 2018. Adult congenital heart disease patients on NOACs had higher thromboembolic (3.8% vs. 2.8%), MACE (7.8% vs. 6.0%), bleeding rates (11.7% vs. 9.0%), and all-cause mortality (4.0% vs. 2.8%; all P &lt; 0.05) after 1 year of therapy compared with VKAs. After comprehensive adjustment for patient characteristics, NOACs were still associated with increased risk of MACE (hazard rate—HR 1.22; 95% CI 1.09–1.36) and increased all-cause mortality (HR 1.43; 95% CI 1.24–1.65; both P &lt; 0.001), but also bleeding (HR 1.16; 95% CI 1.04–1.29; P = 0.007) during long-term follow-up. Conclusion  Despite the lack of prospective studies in ACHD, NOACs are increasingly replacing VKAs and now account for almost half of all oral anticoagulant prescriptions. Particularly, NOACs were associated with excess long-term risk of MACE, and mortality in this nationwide analysis, emphasizing the need for prospective studies before solid recommendations for their use in ACHD can be provided.

scholarly journals Cardiopatia Congénita em Crianças com Síndrome de Down: O que Mudou nas Últimas Três Décadas?

2016 ◽  
Vol 29 (10) ◽  
pp. 613
Author(s):  
Filipa Mestre A. Dias ◽  
Susana Cordeiro ◽  
Isabel Menezes ◽  
Graça Nogueira ◽  
Ana Teixeira ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Down Syndrome ◽  
Heart Disease ◽  
Mortality Rate ◽  
Congenital Heart ◽  
Nyha Class ◽  
Cardiac Complications ◽  
Corrective Surgery ◽  
Reference Hospital ◽  
First Year Of Life

Introduction: The prevalence of Down syndrome has increased in the last 30 years; 55% of these children have congenital heart disease.Material and Methods: A retrospective longitudinal cohort study; clinical data from 1982 to 2013 databases with the diagnosis of Down syndrome or trisomy 21 in a reference hospital in pediatric cardiology and cardiac surgery.Objective: to assess the progress in the last three decades of cardiological care given to children with Down syndrome and congenitalheart disease.Results: We studied 102 patients with Down syndrome and congenital heart disease subjected to invasive therapy: corrective or palliative cardiac surgery and therapeutic catheterization. The referral age was progressively earlier in patients referred in the first year of life. The most frequent diagnosis was complete atrioventricular sptal defect (41%). There was a trend towards increasingly early corrective surgery in patients under 12 months (p < 0.001). Since 2000, the large majority of patients were operated before reaching six months of age. The main cardiac complications were rhythm dysfunction and low output. More frequent noncardiac complications were pulmonary and infectious. The 30-day mortality rate was 3/102 cases (2.9%). Of patients in follow-up, 89% are in NYHA class I.Discussion and Conclusion: The early surgical correction seen over the past 15 years follows the approach suggested in the literature. The observed 30-day mortality rate is overlapping international results. Patients with Down syndrome subjected to corrective surgery of congenital heart disease have an excellent long-term functional capacity.

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