Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 22:7:100314.
doi: 10.1016/j.ijcchd.2021.100314. eCollection 2022 Mar.

Increased prevalence of cardiac and non-cardiac chronic morbidity among adults with congenital heart disease

Doron Portal  1   2 , Rafael Hirsch  2   3 , Michal Benderly  1   2 ; Israeli Adult Congenital Heart Disease Research Group
Affiliations

Increased prevalence of cardiac and non-cardiac chronic morbidity among adults with congenital heart disease

Doron Portal et al. Int J Cardiol Congenit Heart Dis. .

Abstract

Background: Data regarding the prevalence of chronic diseases and comorbidities among Adults with Congenital Heart Disease (ACHD), compared to the general population, are limited.

Methods: This retrospective cohort study, comprised 11,653 ACHD patients (age>18) insured by two large healthcare providers (2007-2011). Logistic regression models were used to estimate adjusted morbidity odds ratio (OR) and the Cox proportional hazard model for estimating mortality hazard ratio (HR). Standardized Morbidity Ratios (SMR) were calculated in reference to an Israeli general population sample.

Results: Diagnosis of chronic disease or risk factor was recorded for 57.6% of patients (Age adjusted rate: 52.7%, 95% Confidence Interval (CI) 51.4-54.0). The prevalence of atherosclerotic cardiovascular disease decreased, while the prevalence of heart failure and pulmonary diseases increased with increasing ACHD complexity. Compared to the general population, ACHD patients were found to have higher morbidity rates for any disease (SMR ​= ​1.69, 95%CI: 1.64-1.74). Heart failure and atherosclerotic cardiovascular diseases were 3-times more prevalent among ACHD patients (SMR ​= ​3.19, 95%CI: 2.92-3.46, and SMR ​= ​3.58, 95%CI: 3.41-3.74, respectively), malignancies were 75% more prevalent. Diagnosis of any chronic disease was associated with increased mortality risk (HR ​= ​1.77, 95%CI: 1.51-2.06), beyond the risk associated with the congenital heart disease complexity (HR ​= ​2.37, 95% CI: 1.81-3.12).

Conclusion: ACHD patients have excess morbidity compared to the general population. Increased mortality is attributed to both defect complexity and comorbidities, therefore, focused interventions for comorbidity prevention and management among ACHD may be required.

Keywords: Adult congenital heart disease; Chronic disease; Comorbidity; Prevalence; Prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Standardized Morbidity Ratio of Chronic Diseases by defect complexity among 8932 Adults with Congenital Heart Defects compared to the General Population of Israel.
See this image and copyright information in PMC

References

    1. Oliver J.M., Gallego P., Gonzalez A.E., Garcia-Hamilton D., Avila P., Yotti R., Ferreira I., Fernandez-Aviles F. Risk factors for excess mortality in adults with congenital heart diseases. Eur Heart J. 2017;38:1233–1241. doi: 10.1093/eurheartj/ehw590. - DOI - PubMed
    1. Diller G.P., Kempny A., Alonso-Gonzalez R., Swan L., Uebing A., Li W., Babu-Narayan S., Wort S.J., Dimopoulos K., Gatzoulis M.A. Survival prospects and circumstances of death in contemporary adult congenital heart disease patients under follow-up at a large tertiary centre. Circulation. 2015;132:2118–2125. doi: 10.1161/CIRCULATIONAHA.115.017202. - DOI - PubMed
    1. Hernandez G.A., Lemor A., Clark D., Blumer V., Burstein D., Byrne R., Fowler R., Frischhertz B., Sandhaus E., Schlendorf K., Zalawadiya S., Lindenfeld J.A., Menachem J.N. Heart transplantation and in-hospital outcomes in adult congenital heart disease patients with Fontan: a decade nationwide analysis from 2004 to 2014. J Card Surg. 2020;35:603–608. doi: 10.1111/jocs.14430. - DOI - PubMed
    1. Naidu P., Grigg L., Zentner D. Mortality in adults with congenital heart disease. Int J Cardiol. 2017;245:125–130. doi: 10.1016/j.ijcard.2017.05.132. - DOI - PubMed
    1. Oechslin E.N., Harrison D.A., Connelly M.S., Webb G.D., Siu S.C. Mode of death in adults with congenital heart disease. Am J Cardiol. 2000;86:1111–1116. https://doi.org/S0002-9149(00)01169-3 [pii] - PubMed

LinkOut - more resources