Abstract 13924: Unresolved Medical Conditions have become the Leading Cause of Death in Children with Heart Disease
Background: Despite significant surgical and medical advances over the past decades, there has been a low but persistent mortality rate for children with heart disease as well as adults with congenital heart disease. We sought to determine whether the primary unresolved conditions leading to death in these patients had changed over the past decade.
Methods: We reviewed medical records for 100 deaths of cardiac patients in 1995/1996 and 100 deaths in 2004/2005. Demographic, clinical, and procedural data as well as circumstances of death were collected. An expert consensus committee reviewed each case in order to determine the unresolved surgical or medical condition leading to death, according to 15 pre-defined categories.
Results: There were few differences in cardiac diagnoses, prior cardiac surgeries, comorbid conditions, or age at death between the two time periods. However, of the 100 patient deaths in 1995/1996, 46% occurred within 30 days of cardiac surgery. This rate was nearly halved by 2004/2005 (24%; p=0.002). A similar shift was observed regarding death within 30 days of cardiac catheterizations. Furthermore, the unresolved medical/surgical conditions leading to death in both time periods changed significantly: 51% of patient deaths in 1995/1996 resulted from a primarily surgical problem, 29% from a non-surgical medical condition. This ratio was reversed in 2004/2005: Only 31% of patient deaths were due to an unresolved surgical problem while 50% of deaths resulted from a medical condition (p=0.005). The three medical conditions most commonly leading to death in 2004/2005 were pulmonary arterial hypertension (12%), pulmonary vein stenosis (12%), and myocardial failure (10%). Ten years ago, these conditions together accounted for merely 12% of patient deaths.
Conclusion: Compared to a decade ago, cardiac patients today survive longer after cardiac surgery and/or cardiac catheterization. Deaths within 30 days of procedure have decreased significantly. While surgical problems accounted for the majority of deaths in 1995/1996, most cardiac patient deaths today result from unresolved medical conditions. This illustrates that optimizing the medical management needs to become a priority for future clinical initiatives and training.
- © 2011 by American Heart Association, Inc.