Congenital heart disease and comorbidities in primary care: a cross-sectional study

Abstract

Background/Aims Patients with congenital heart disease are living longer as a result of surgical and medical advances. General practice is key in identifying and supporting lifelong care, yet there is a lack of research into congenital heart disease in this area. This study aimed to explore the prevalence and comorbidities of patients with congenital heart disease compared to those without congenital heart disease in primary care settings in Cheshire, England. Methods This cross-sectional study used routinely collected health data from the NHS general practice population information disease database within primary care in Cheshire. Clinical read codes for congenital heart disease were added to the current data analytics risk stratification tool. Searches for patients of all ages with and without congenital heart disease were undertaken in July 2022. A total of 765 576 patients were included in the study. Results Of 765 576 patient records, 6419 patients were coded with congenital heart disease, a prevalence of 0.8%, with a comparatively younger age compared with the non-congenital heart disease cohort. Patients with congenital heart disease were three times more likely to have heart failure (odds ratio=3.36; 95% confidence interval=2.96−3.81) or stroke (odds ratio=3.58; 95% confidence interval=3.24–3.94). The most frequent comorbidities in both groups were hypertension, anxiety and depression, with no significant difference between the groups. Among those with congenital heart disease, the prevalence of a learning disability was more than eight times higher than those without congenital heart disease (odds ratio=9.23; 95% confidence interval=8.16–10.55) and autism was three times more likely (odds ratio=2.98; 95% confidence interval=2.32–3.84) in those with congenital heart disease. Conclusions There are high rates of comorbidities in the congenital heart disease population in primary care. Innovative use of digital instruments can enable identification and risk stratification of patients with congenital heart disease to support lifelong care. Congenital heart disease guidance should include primary care settings to create opportunities for mutual learning that can enhance collaborative practice.