Abstract 19270: Heart Failure Incidence is Elevated in Adults With Simple Congenital Heart Defects Compared With the General Population: A Cohort Study
Heart failure (HF) is a major cause of morbidity and mortality in adults with congenital heart defects (CHD). However, few data exist on the long-term prognosis of simple CHD. We aimed to estimate the incidence of HF and use of HF drugs in individuals with simple CHD compared with the general population.
Methods: We identified a nationwide population-based simple CHD cohort, defined by isolated and uncomplicated secundum atrial septal defect (ASD), persistent ductus arteriosus (PDA), ventricular septal defect (VSD) judged to be either muscular or with normal pulmonary flow resistance, or mild pulmonary stenosis (PS) verified by catheterization. Subjects were born and diagnosed from 1963 through 1973 in Denmark. We included patients with no childhood co-morbidity who were alive at 32 years of age (this age was determined by the establishment of a nationwide prescription register in 1995). For each CHD subject, we identified 10 control individuals from the general population using the Danish Civil Registration System, matched by sex and birth year. A unique personal identifier used in all Danish public registries enabled virtually complete follow-up for migration, death, use of HF drugs, or HF diagnoses as identified in a hospital discharge registry covering all Danish hospitals since 1977. Specific indications for drug use were unknown (could be e.g. hypertension). We computed cumulative incidence of first diagnosis of HF and first filling of a HF drug prescription, for CHD subjects and controls, and the corresponding hazard ratios (HR).
Results: We identified 802 CHD subjects (ASD, n=115; VSD, n=437; PS, n=75; PDA, n=175) and 7,947 controls, 43% male. Cumulative incidence for CHD subjects by age 45 years of HF drug use was 22% (16% for controls), whereas it was 3% (0.4% for controls) for a HF hospital diagnosis. The corresponding HRs comparing CHD subjects with controls were 1.4(95% CI:1.2-1.6) and 6.9(95% CI:4.0-12).
Conclusion: Adults with simple CHDs were at increased risk of HF. The data on HF drug use should be interpreted with caution as other cardiovascular conditions were likely the indications for many of the prescriptions. However; further studies on the effectiveness of medical follow-up programs for patients with simple CHDs appear warranted.
Author Disclosures: M. Olsen: None. D.E. Høfsten: None. N.L. Madsen: None. H.B. Laursen: None. S.P. Johnsen: None. J. Videbæk: None.
- © 2015 by American Heart Association, Inc.