Abstract 1872: Geriatric Congenital Heart Disease: Trends in Prevalence and Predictors of Mortality
Background: Mortality in congenital heart disease (CHD) has shifted away from the young and towards the older adults. We sought to determine the temporal trends in prevalence of older adults with CHD, and to measure the impact of CHD lesions and comorbid conditions on late mortality.
Methods: We performed a nested-case control study within a population-based CHD database constructed from administrative data on all CHD patients who came into contact with the healthcare system in Quebec between 1990 and 2005. The primary outcome of interest was all-cause mortality. The effects of predictors on mortality were evaluated by multivariate logistic regression and reported as odds ratios (OR) with 95% confidence intervals (CI).
Results: We identified 12,095 older adults (age ≥65) with specific CHD diagnoses. From 1990 to 2005, the proportion of older adults in our CHD cohort did not increase (9.3% vs. 8.1%) whereas the proportion of older adults in the general population increased modestly (10.8% vs. 13.8%). During this time, the prevalence of severe lesions remained similar in older adults with CHD (4.2% vs. 3.7%), as did the prevalence of shunt lesions (56.1% vs. 61.0%) and valvular lesions (39.7% vs. 35.3%). The mean age was 76.8 +/− 8.0 years. We observed 2,419 deaths, and found that age and comorbid conditions were predictive of mortality whereas type of CHD lesion was not. In particular, chronic kidney disease (OR 3.06, 95% CI 2.49 to 3.77), heart failure (OR 2.86, 95% CI 2.55 to 3.21), myocardial infarction (OR 2.56, 95% CI 2.22 to 2.94), and malignant cancer (OR 2.14, 95% CI 1.92 to 2.40) were the most powerful predictors of mortality.
Conclusions: Among older adults surviving to age 65 with CHD, mortality was influenced by age, cardiovascular disease, renal disease, and cancer. The prevalence of severe lesions remains low in the geriatric CHD population, and CHD patients are living long enough to acquire comorbid conditions. This underscores the importance of managing common diseases in older adults with CHD.