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.

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.

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

Changing Profile of Congenital Heart Disease

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 790-791
Author(s):  
D. WOODROW BENSON ◽  
James Moller ◽  
Donald C. Fyler ◽  
David E. Fixler
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Surgical Treatment ◽  
Congenital Heart ◽  
Considerable Change ◽  
Diagnostic Methods ◽  
Younger Patients ◽  
The Past ◽  
Steady Improvement ◽  
Complex Lesions

In the past 20 years, considerable change has occurred in the profile of congenital heart disease regarding both diagnosis and treatment. The profile has changed from older to younger patients; the essence of this change has been from pediatric to infant to neonatal cardiology. There has been a shift from palliative to more definitive surgical procedures and a change from invasive (cardiac catheterization) to noninvasive (echocardiography) diagnostic methods. The profile has changed from definitive surgical treatment limited to simple lesions to surgical treatment of the most complex lesions. There has been steady improvement in the recognition of cases of congenital heart disease. Of all children admitted to hospitals for treatment of congenital heart disease, the portion less than three days of age has increased from 24% in 1969 to 1972 to 33% in 1982 to 1986.

An Atlas of Congenital Heart Disease

PEDIATRICS ◽  
1963 ◽  
Vol 32 (6) ◽  
pp. 1077-1077
Author(s):  
NORMAN J. SISSMAN
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Clinical Management ◽  
Congenital Heart ◽  
Pathological Examination ◽  
Children's Hospital ◽  
The Past ◽  
Present Volume ◽  
Children’S Hospital

Despite the vast experience accumulated during the past decade with all aspects of the lives and deaths of patients with congenital heart disease, there is still room for the clarification and direction that careful, informed, imaginative analysis of the results of pathological examination of postmortem material can give to the clinical management of these patients. Dr. Sherman has made a notable contribution in this area with the present volume. The atlas was compiled from 503 specimens collected in the Museum of Congenital Heart Disease at the Children's Hospital in Pittsburgh since 1954.

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 Association of Insurance Status With Emergent Versus Nonemergent Hospital Encounters Among Adults With Congenital Heart Disease

2021 ◽  
Vol 10 (19) ◽  
Author(s):  
Anushree Agarwal ◽  
Michelle Gurvitz ◽  
Janet Myers ◽  
Sarthak Jain ◽  
Abigail M. Khan ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Health Planning ◽  
Private Insurance ◽  
Insurance Status ◽  
The Past ◽  
Use Of Resources ◽  
Hospital Visits ◽  
The Relationship

Background Although the number of hospital visits has exponentially increased for adults with congenital heart disease (CHD) over the past few decades, the relationship between insurance status and hospital encounter type remains unknown. The purpose of this study was to evaluate the association between insurance status and emergent versus nonemergent encounters among adults with CHD ≥18 years old. Methods and Results We used California Office of Statewide Health Planning and Development Database from January 2005 to December 2015 to determine the trends of insurance status and encounters and the association of insurance status on encounter type among adults with CHD. A total 58 359 nonpregnancy encounters were identified in 6077 patients with CHD. From 2005 to 2015, the number of uninsured encounters decreased by 38%, whereas government insured encounters increased by 124% and private by 79%. Overall, there was a significantly higher proportion of emergent than nonemergent encounters associated with uninsured status (13.0% versus 1.8%; P <0.0001), whereas the proportion of nonemergent encounters associated with private insurance was higher than emergent encounters (35.8% versus 62.4%; P <0.0001). When individual patients with CHD became uninsured, they were ≈5 times more likely to experience an emergent encounter ( P <0.0001); upon changing from uninsured to insured, they were significantly less likely to have an emergent encounter ( P <0.001). After multivariate adjustment, uninsured status exhibited the highest odds of an emergent rather than nonemergent encounter compared with all other covariates (adjusted odds ratio, 9.20; 95% CI, 7.83–10.8; P <0.0001). Conclusions Efforts to enhance the ability to obtain and maintain insurance throughout the lifetime of patients with CHD might result in meaningful reductions in emergent encounters and a more efficient use of resources.

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.

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