Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany.
Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
Clin Res Cardiol. 2024 May;113(5):750-760. doi: 10.1007/s00392-023-02370-6. Epub 2024 Mar 4.
Congenital heart defects (CHD) are still associated with an increased morbidity and mortality. The aim of this study was to analyze trends of mortality rates in patients with CHD between 1998 and 2018 in Germany.
Data of registered deaths with an underlying diagnosis of CHD were used to evaluate annual mortality between 1998 and 2018. Polynomial regressions were performed to assess annual changes in CHD-associated mortality rates by age groups.
During the 21-year study period, a total of 11,314 deaths were attributed to CHD with 50.9% of deaths in infants (age < 1 year) and 28.2% in neonates (age ≤ 28 days). The most frequent underlying CHDs associated with death were hypoplastic left heart syndrome (n = 1498, 13.2%), left ventricular outflow tract obstruction (n = 1009, 8.9%), atrial septal defects (n = 771, 6.8%), ventricular septal defects (n = 697, 6.2%), and tetralogy of Fallot (n = 673, 5.9%), and others (n = 6666, 58.9%). Among all patients, annual CHD-related mortality rates declined significantly between 1998 and 2010 (p < 0.0001), followed by a significant annual increase until 2018 (p < 0.0001). However, mortality rates in 2018 in all ages were significantly lower than in 1998.
Mortality in CHD patients decreased significantly between 1998 and 2010, but a substantial number of deaths still occurred and even significantly increased in the last 3 years of the observation period particularly in neonates and infants. This renewed slight increase in mortality rate during the last years was influenced mainly by high-risk neonates and infants. Assessment of factors influencing the mortality rate trends in association with CHD in Germany is urgently needed. Obligatory nationwide registration of death cases in relation to surgical and catheter interventions in CHD patients is necessary to provide additional valuable data on the outcome of CHD.
先天性心脏病（CHD）仍然与发病率和死亡率的增加有关。本研究的目的是分析 1998 年至 2018 年德国 CHD 患者死亡率的趋势。
使用登记有 CHD 基础诊断的死亡数据，评估 1998 年至 2018 年期间的年度死亡率。通过年龄组进行多项式回归，评估 CHD 相关死亡率的年度变化。
在 21 年的研究期间，共有 11314 例死亡归因于 CHD，其中 50.9%的死亡发生在婴儿（年龄<1 岁），28.2%的死亡发生在新生儿（年龄≤28 天）。与死亡最相关的最常见基础 CHD 是左心发育不全综合征（n=1498，13.2%）、左心室流出道梗阻（n=1009，8.9%）、房间隔缺损（n=771，6.8%）、室间隔缺损（n=697，6.2%）和法洛四联症（n=673，5.9%）以及其他（n=6666，58.9%）。在所有患者中，1998 年至 2010 年间，CHD 相关死亡率呈显著下降趋势（p<0.0001），随后在 2018 年呈显著上升趋势（p<0.0001）。然而，2018 年所有年龄段的死亡率均明显低于 1998 年。
1998 年至 2010 年间，CHD 患者的死亡率显著下降，但仍有大量死亡发生，特别是在观察期的最后 3 年，新生儿和婴儿的死亡率甚至显著上升。在过去几年中，死亡率的这种轻微回升主要受到高危新生儿和婴儿的影响。迫切需要评估德国与 CHD 相关的死亡率趋势相关的影响因素。有必要在全国范围内对与 CHD 患者手术和导管干预相关的死亡病例进行强制性登记，以提供有关 CHD 结果的额外有价值数据。
