Increased prevalence of cardiac and non-cardiac chronic morbidity among adults with congenital heart disease.

BACKGROUND

Data regarding the prevalence of chronic diseases and comorbidities among Adults with Congenital Heart Disease (ACHD), compared to the general population, are limited.

METHODS

This retrospective cohort study, comprised 11,653 ACHD patients (age>18) insured by two large healthcare providers (2007-2011). Logistic regression models were used to estimate adjusted morbidity odds ratio (OR) and the Cox proportional hazard model for estimating mortality hazard ratio (HR). Standardized Morbidity Ratios (SMR) were calculated in reference to an Israeli general population sample.

RESULTS

Diagnosis of chronic disease or risk factor was recorded for 57.6% of patients (Age adjusted rate: 52.7%, 95% Confidence Interval (CI) 51.4-54.0). The prevalence of atherosclerotic cardiovascular disease decreased, while the prevalence of heart failure and pulmonary diseases increased with increasing ACHD complexity. Compared to the general population, ACHD patients were found to have higher morbidity rates for any disease (SMR ​= ​1.69, 95%CI: 1.64-1.74). Heart failure and atherosclerotic cardiovascular diseases were 3-times more prevalent among ACHD patients (SMR ​= ​3.19, 95%CI: 2.92-3.46, and SMR ​= ​3.58, 95%CI: 3.41-3.74, respectively), malignancies were 75% more prevalent. Diagnosis of any chronic disease was associated with increased mortality risk (HR ​= ​1.77, 95%CI: 1.51-2.06), beyond the risk associated with the congenital heart disease complexity (HR ​= ​2.37, 95% CI: 1.81-3.12).

CONCLUSION

ACHD patients have excess morbidity compared to the general population. Increased mortality is attributed to both defect complexity and comorbidities, therefore, focused interventions for comorbidity prevention and management among ACHD may be required.