Abstract 16389: Predictors of Outcome in Adults with Congenital Heart Disease over 60 Years of Age
Background The population of adults with congenital heart disease (ACHD) is growing and aging. Little is known about prognostic parameters in the emerging geriatric ACHD population.
Methods and Results This is a single center study on all patients with congenital heart disease with age over 60 years and under regular follow up between 2000 and 2012. All-cause mortality was used as the primary outcome. Out of a total population of 7315 ACHD patients under regular follow-up at our clinic, 376 patients (female n= 191 [50.8%], mean age 64.8 ± 5.8 years) fulfilled the inclusion criteria. Of these 45% had simple lesions, 47% moderate-complexity lesions and 8% complex heart lesions. Between 2000 (37 patients) and 2012 (321 patients) there was a 8.7-fold increase in elderly patients under regular follow-up. During a median follow up time of 5.5 (IQR 3.1-8.6) years, 55 patients died. On multivariate Cox proportional hazards analysis, the presence of coronary artery disease (hazard ratio [HR]: 7.82; 95%CI: 2.75-22.25, p<0.001), chronic kidney disease (HR: 6.29; 95%CI: 1.01-39.07, p=0.049), history of stroke/TIA (HR: 3.46; 95%CI: 1.12-10.68, p=0.03), New York Heart Association class (HR: 2.39; 95%CI: 1.45-3.94, p<0.001), and systemic ventricular dysfunction (HR: 2.23; 95%CI: 1.46-3.70, p<0.001) emerged as the strongest prognostic factors.
Conclusion There is a substantial and growing number of elderly patients with congenital heart disease. As ACHD patients grow older, acquired morbidity such as coronary artery disease and renal dysfunction become ever more important in defining outcome together with the underlying congenital heart defect.
- © 2012 by American Heart Association, Inc.