Incidence and correlates of mortality in adults with congenital heart disease of different age groups

Abstract

Background: Aging is associated with acquired comorbidities that potentially influence the natural history and outcomes of adults with congenital heart disease (CHD). The purpose of this study was to compare the clinical characteristics, as well as the incidence and correlates of all-cause mortality between different age groups. Method: Adults with CHD were categorized into 3 age groups based on age at baseline encounter: Group 1 (age 18–40 years); Group 2 (age 41–65 years), and Group 3 (age >65 years). Results: Of 5930 patients (age 37 ± 15 years), 3009 (51%), 2422 (41%), and 499 (8%) were in Groups 1, 2 and 3, respectively. Compared to Group 1, patients in Groups 2 and 3 were less likely to have complex CHD, but more likely to have acquired comorbidities, end-organ dysfunction, ventricular systolic dysfunction, and valvular heart disease. Compared to Group 1, Groups 2 and 3 had higher incidence of all-cause mortality (7.2 versus 15.3 versus 47.8 per 1000 patient-years, respectively, p < 0.001), and lower proportion of deaths from cardiovascular causes (87% versus 77% versus 71%, respectively, p < 0.001). Furthermore, the correlates of all-cause mortality were different between the age groups, with acquired comorbidities such as hypertension, coronary artery disease, and hepatorenal dysfunction being associated with mortality in Group 3, while indices of CHD severity such as number of prior cardiac surgery, and presence of complex CHD being associated with all-cause mortality in Group 1. Conclusions: These results suggest the need for management strategies tailored to address the correlates of outcomes in each age group.

Keywords

• Congenital heart disease
• Age
• Comorbidities
• Prognostication