Congenital heart disease: an ageing problem
Congenital heart disease (CHD) is the most common congenital anomaly, with an estimated prevalence of eight per 1,000 births.1 However, reliable data on long-term survival for this heterogeneous group of patients are still lacking. Previous population-based studies from the US reported age-standardised mortality rates secondary to CHD of 1.2 per 100,000.2 Mortality was highest during infancy (48.1% of all deaths occurred under the age of one year), however, the majority of the remaining deaths occurred outside of childhood, following transition to adult care. Yet, while it is accepted that individuals with CHD may have a higher mortality compared with the general population, the wide spectrum of disease means interpretation of population-based mortality rates for individual lesions is difficult. Additionally, a significant number of studies report only on short-term follow-up, meaning that long-term outcomes are unknown. A previous systematic review reported pooled survival estimates for common CHD lesions, however, it only included studies from hospital-based cohorts with survival estimates calculated from the time of surgical repair.3 It, therefore, does not account for those patients who do not need surgical intervention and may not be representative of all patients with CHD. Knowing the expected mortality rates for CHD is not only important for family counselling, but also in service planning.