Elsevier

Cardiology Clinics

Volume 33, Issue 4, November 2015, Pages 503-512
Cardiology Clinics

Adult Congenital Heart Disease: Scope of the Problem

https://doi.org/10.1016/j.ccl.2015.07.001Get rights and content

Section snippets

Key points

  • •

    Birth prevalence of congenital heart disease (CHD) can be modified by many factors, including prenatal care, pregnancy termination and prevention, and changing sex distribution of the adult CHD population.

  • •

    As a result of decreasing mortality and increasing survival in all forms of CHD, the median age of patients has increased and adults now compose two-thirds of patients with CHD.

  • •

    Disease burden and resulting health services utilization increase significantly across the life span of the CHD

Incidence and Birth Prevalence of Congenital Heart Disease

The product of CHD incidence and survival determines the prevalence of CHD at all ages. Thus a clear understanding of the determinants of the incidence of CHD is important in understanding the challenges of measurement using empirical data. The exact incidence of CHD cannot be accurately measured because it would require tracking the number of new cases of CHD from conception in utero. Thus, the best proxy available to estimate the incidence of new cases of CHD born each year is birth prevalence

Disease Burden

The unique needs of this population center around life-long comorbidities.21 Using the Quebec CHD database, the impact on morbidity and mortality of ongoing disease burden in those with atrial arrhythmias,22 pulmonary hypertension,23 infective endocarditis,24 cardiovascular risk factors,25 and the repeated need for interventions was documented.26

The impact on mortality remains a hard outcome targeted by clinicians, health services researchers, and administrators. The shift in mortality from

Bridging the policy to quality gap

Policy matters because CHD is a life-span disease associated with high HSU and, therefore, high health care costs. Working with policy makers we can impact resource allocation increasing capacity in terms of structure and process elements of health care delivery that will allow us to shape quality of care moving forward, ultimately impacting outcomes. Quality of care matters because it gives us the opportunity to achieve desired health outcomes. The purpose of improving quality is to provide

Summary and future directions

The prevalence of CHD on a population level is determined by birth prevalence of CHD and survival of CHD across the life span. With substantial improvement in survival, the prevalence of CHD in adults continues to increase. Two-thirds of the entire CHD population is now composed of adults, including those with severe CHD. With mortality shifts away from infants and toward adults, the landscape of comorbidity is changing. Although cardiac complications of the CHD lesion continues to account for

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    Disclosures: The authors have no conflict of interest to disclose. Dr A.J. Marelli is a Clinical Scholar of the Fonds de Recherche Santé Québec whose research is supported by the Heart and Stroke Foundation of Canada and the Canadian Institute of Health Research, both of which are publically funded institutions.

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