Impact of age and sex on survival and causes of death in adults with congenital heart disease. (15th October 2017)

• Record Type: Journal Article
• Authors: Oliver, Jose Maria; Gallego, Pastora; Gonzalez, Ana Elvira; Garcia-Hamilton, Diego; Avila, Pablo; Alonso, Andres; Ruiz-Cantador, Jose; Peinado, Rafael; Yotti, Raquel; Fernandez-Aviles, Francisco
• Is Part Of: International journal of cardiology. Volume 245(2017)
• Page Start: 119
• Page End: 124
• Publication Date: 2017-10-15
• Subjects: Adult congenital heart disease -- Survival -- Cause (of) death -- Aging -- Gender; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.06.060
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The impact of gender and aging on relative survival and causes of death in adults with congenital heart disease (ACHD) are not well known. Methods: Single center observational longitudinal study of 3311 consecutive ACHD (50.5% males) followed up to 25 years. Patients were divided by the age at last follow-up into three groups: < 40, 40–65 and > 65 years old. Their vital status was verified by crosschecking the Spanish National Death Index. Regression model for relative survival from reference population was performed. Cause of death was classified according to the International Classification of Diseases (ICD-10). Patients who died from cardiovascular (CV) causes were further investigated on a case-by-case basis. Results: During a cumulative follow-up time of 37, 608 person-years 336 patients died (10%). Age-adjusted relative survival in females was significantly worse than in males (hazard ratio [HR] 1.25; 95% confidence interval [CI] 1.0–1.6; p = 0.046), and sex-adjusted relative survival improved across the three group of ages (HR 0.98; 95% CI 0.97–0.99; p < 0.001). There was a temporal decline of CV deaths with aging in both genders (p < 0.001). The leading cause of CV death was heart failure but sudden death prevailed in subjects < 40 years (p = 0.004). While sudden death progressively declined with aging heart failure significantly increased (p < 0.001). Conclusions: Women with CHD fare worse than men. There are a decline in CV deaths and a major temporal shift in the causes of CV deaths with aging. Heart failure surpasses sudden death as the primary cause of death in survivors over 40 years.