Liu Aihua, Diller Gerhard-Paul, Moons Philip, Daniels Curt J, Jenkins Kathy J, Marelli Ariane
McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Centre, Montréal, Québec, Canada.
Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
Nat Rev Cardiol. 2023 Feb;20(2):126-137. doi: 10.1038/s41569-022-00749-y. Epub 2022 Aug 31.
The epidemiology of congenital heart disease (CHD) has changed in the past 50 years as a result of an increase in the prevalence and survival rate of CHD. In particular, mortality in patients with CHD has changed dramatically since the latter half of the twentieth century as a result of more timely diagnosis and the development of interventions for CHD that have prolonged life. As patients with CHD age, the disease burden shifts away from the heart and towards acquired cardiovascular and systemic complications. The societal costs of CHD are high, not just in terms of health-care utilization but also with regards to quality of life. Lifespan disease trajectories for populations with a high disease burden that is measured over prolonged time periods are becoming increasingly important to define long-term outcomes that can be improved. Quality improvement initiatives, including advanced physician training for adult CHD in the past 10 years, have begun to improve disease outcomes. As we seek to transform lifespan into healthspan, research efforts need to incorporate big data to allow high-value, patient-centred and artificial intelligence-enabled delivery of care. Such efforts will facilitate improved access to health care in remote areas and inform the horizontal integration of services needed to manage CHD for the prolonged duration of survival among adult patients.
在过去50年里，由于先天性心脏病（CHD）患病率和生存率的上升，其流行病学情况发生了变化。特别是自20世纪后半叶以来，由于诊断更加及时以及CHD干预措施的发展延长了患者寿命，CHD患者的死亡率发生了显著变化。随着CHD患者年龄增长，疾病负担从心脏转移至获得性心血管和全身性并发症。CHD的社会成本高昂，不仅体现在医疗保健利用方面，还涉及生活质量。对于疾病负担高且在较长时间段内进行衡量的人群，确定可改善的长期结局，其寿命疾病轨迹变得越来越重要。包括过去10年中针对成人CHD的高级医师培训在内的质量改进举措，已开始改善疾病结局。当我们试图将寿命转化为健康寿命时，研究工作需要纳入大数据，以实现高价值、以患者为中心且借助人工智能的医疗服务提供。此类努力将有助于改善偏远地区的医疗保健可及性，并为管理成年患者CHD以延长生存期所需的服务横向整合提供信息。
