NEW ORLEANS — Over the past 2 decades, patients with congenital heart disease have increasingly lived to an older age, according to data collected on about 70,000 CHD patients living in Quebec.
The rising age of death has been most dramatic among children younger than 10, probably because of improved surgical management of severe congenital heart defects, Dr. Paul Khairy said at the annual meeting of the American College of Cardiology. During 1988–1989, the median age of death was 8 years among patients with severe CHD in Quebec (except those younger than 1 year). By 2004–2005, the median age of death in this group had soared to 42 years, said Dr. Khairy, a cardiologist and epidemiologist at the Montreal Heart Institute.
Because of these changes in mortality, “the burden of CHD has shifted to older patients,” he said.
His analysis used data collected on the more than 70,000 Quebec residents with a diagnosed CHD who were at least 1 year old and alive for some period in 1988–2005.
The analysis then focused on the 45,651 people with CHD alive during 1988–1989, and the 62,052 alive with CHD during 2004–2005. The overall mortality of these patients was 4.6/1,000 patients in 1988–1989, and 10.3/1,000 patients in 2004–2005.
A breakdown of death rates by age showed a pronounced bimodal distribution in 1988–1989, with one peak occurring among children aged 10 and younger and the second peak occurring at age 61–76. During this year, about 13% of deaths among all people with CHD occurred among children aged 1–5, and about 8% of the deaths were in children aged 6–10. In contrast, the early childhood peak had largely disappeared by 2004–2005. During that year, about 3% of the deaths were in children aged 1–5, and about 1% were in those aged 6–10. The mortality pattern by age in patients with CHD during 2004–2005 was similar to the pattern for the overall Quebec population, with the peak age of death occurring at about 71–90 years, Dr. Khairy said.
Another analysis focused on the patients with severe forms of CHD, defined as an endocardial cushion defect, tetralogy of Fallot, a univentricular heart, transposition of the great arteries, truncus arteriosus, and hypoplastic left heart syndrome. In this subgroup, the mortality rate was about 43% among children aged 1–4 in 1988–1989; the rate dropped to about 10% by 2004–2005. Among children aged 5–9, mortality was about 18% in 1988–1989, falling to about 7% in 2004–2005.
The overall median age of death in all patients with CHD was 61 years in 1988–1989 and 68 years in 2004–2005, a statistically significant increase, Dr. Khairy said.